MEDICARE: DR. MARC FEDER D.P.M.

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	213E00000X	Podiatrist		IL

General Provider Information

NPI Number	:	1881688265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC FEDER D.P.M.

Provider Business Mailing Address
First Line	:	4211 N CICERO AVE
Second Line	:	SUITE 301
City	:	CHICAGO
State	:	IL
Zip	:	60641-1649
Country	:	US
Telephone Number	:	773-202-8800
Fax Number	:	773-202-8810

Provider Business Practice Location Address
First Line	:	4211 N CICERO AVE
Second Line	:	SUITE 301
City	:	CHICAGO
State	:	IL
Zip	:	60641-1651
Country	:	US
Telephone Number	:	773-202-8800
Fax Number	:	773-202-8810

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	01/25/2008

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