Provider Demographics
NPI:1497982813
Name:TRAVERSO, VINCENT JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JAMES
Last Name:TRAVERSO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3006
Mailing Address - Country:US
Mailing Address - Phone:708-785-7076
Mailing Address - Fax:
Practice Address - Street 1:10 E 22ND ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4977
Practice Address - Country:US
Practice Address - Phone:630-953-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005445213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery