Provider Demographics
NPI:1174511174
Name:FLANAGAN, JOHN T (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6304 N NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-3614
Mailing Address - Country:US
Mailing Address - Phone:773-853-0081
Mailing Address - Fax:773-853-2970
Practice Address - Street 1:6304 N NAGLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-3614
Practice Address - Country:US
Practice Address - Phone:773-853-0081
Practice Address - Fax:773-853-2970
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004189213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37550Medicare UPIN
IL985190Medicare PIN
IL5227110001Medicare NSC