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NPI Code Detail

MEDICARE: DR. PHILIP JOSEPH GIANFORTUNE D.P.M.

MEDICARE:  DR. PHILIP JOSEPH GIANFORTUNE  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
1213E00000XPodiatrist016003362IL

General Provider Information

NPI Number : 1932107745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP JOSEPH GIANFORTUNE D.P.M.
Provider Business Mailing Address
First Line : 2611 W SUPERIOR ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-1110
Country : US
Telephone Number : 773-235-5090
Fax Number :
Provider Business Practice Location Address
First Line : 2611 W SUPERIOR ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-1110
Country : US
Telephone Number : 773-235-5090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 08/23/2010

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Directions to “ DR. PHILIP JOSEPH GIANFORTUNE D.P.M.” Practice Location

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