MEDICARE: GREGORY TERRY AMARANTOS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	016-003331	IL
2	213E00000X	Podiatrist	016-003331	IL

General Provider Information

NPI Number	:	1811988041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY TERRY AMARANTOS DPM

Provider Business Mailing Address
First Line	:	1660 FEEHANVILLE DR STE 450
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-6023
Country	:	US
Telephone Number	:	847-390-7666
Fax Number	:	473-909-3458

Provider Business Practice Location Address
First Line	:	5215 N CALIFORNIA AVE STE F605
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8564
Country	:	US
Telephone Number	:	847-390-7666
Fax Number	:	847-390-9345

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2005
Last Update Date	:	12/21/2021

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