Provider Demographics
NPI:1073765970
Name:DAVID B HILTZIK PC
Entity Type:Organization
Organization Name:DAVID B HILTZIK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:HILTZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-336-3338
Mailing Address - Street 1:1720 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3502
Mailing Address - Country:US
Mailing Address - Phone:847-336-3338
Mailing Address - Fax:847-336-0683
Practice Address - Street 1:1720 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3502
Practice Address - Country:US
Practice Address - Phone:847-336-3338
Practice Address - Fax:847-336-0683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004380213ES0103X
261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL922980Medicare PIN