Provider Demographics
NPI:1467640177
Name:CATHERINE J MINNICK DPM PC
Entity Type:Organization
Organization Name:CATHERINE J MINNICK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-549-0323
Mailing Address - Street 1:561 W DIVERSEY PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6068
Mailing Address - Country:US
Mailing Address - Phone:773-549-0323
Mailing Address - Fax:
Practice Address - Street 1:561 W DIVERSEY PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-6068
Practice Address - Country:US
Practice Address - Phone:773-549-0323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003251213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0060001266OtherBCBSIL
IL016003251Medicaid
IL0060001266OtherBCBSIL
ILT37715Medicare UPIN