MEDICARE: DR. DARRELL R LATVA 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	213ES0131X	Foot Surgery Podiatrist	016-003092	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902890395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRELL R LATVA DPM

Provider Business Mailing Address
First Line	:	3537 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0035
Country	:	US
Telephone Number	:	708-786-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3935
Country	:	US
Telephone Number	:	773-722-2712
Fax Number	:

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	02/22/2012

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