Provider Demographics
NPI:1124036546
Name:HACKEL, DAWN R (DPM)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:HACKEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3702
Mailing Address - Country:US
Mailing Address - Phone:708-344-4300
Mailing Address - Fax:708-344-4358
Practice Address - Street 1:153 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3702
Practice Address - Country:US
Practice Address - Phone:708-344-4300
Practice Address - Fax:708-344-4358
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5047180002332B00000X
IL016004903213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA6978OtherMEDICARE RAILROAD
IL207728Medicare PIN
ILDA6978OtherMEDICARE RAILROAD
IL214287Medicare PIN
IL5047180002Medicare NSC