Provider Demographics
NPI:1508823691
Name:HETTINGER PODIATRY CENTER, PC
Entity Type:Organization
Organization Name:HETTINGER PODIATRY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:HETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-682-3338
Mailing Address - Street 1:59 DANADA SQ E
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8484
Mailing Address - Country:US
Mailing Address - Phone:630-682-3338
Mailing Address - Fax:630-682-5836
Practice Address - Street 1:2030 APPALOOSA CT W
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8922
Practice Address - Country:US
Practice Address - Phone:630-682-3338
Practice Address - Fax:630-682-5836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003842213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherCORPORATE TAX ID
ILK19310Medicare ID - Type UnspecifiedMEDICARE CROUP ID
ILT37308Medicare UPIN
IL211992Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID