Provider Demographics
NPI:1508365529
Name:PODIATRY OF ARLINGTON HEIGHTS, PC
Entity Type:Organization
Organization Name:PODIATRY OF ARLINGTON HEIGHTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-636-9522
Mailing Address - Street 1:665 N VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-4193
Mailing Address - Country:US
Mailing Address - Phone:847-636-9522
Mailing Address - Fax:
Practice Address - Street 1:8 N DUNTON AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1426
Practice Address - Country:US
Practice Address - Phone:847-255-5004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005609Medicaid