Provider Demographics
NPI:1558703298
Name:NASSER, AUDEY (DPM)
Entity Type:Individual
Prefix:
First Name:AUDEY
Middle Name:
Last Name:NASSER
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 1:731 S IL ROUTE 21 STE 140
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3812
Mailing Address - Country:US
Mailing Address - Phone:847-295-9300
Mailing Address - Fax:847-295-9607
Practice Address - Street 1:731 S IL ROUTE 21 STE 140
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3812
Practice Address - Country:US
Practice Address - Phone:847-295-9300
Practice Address - Fax:847-295-9607
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002505213EP1101X, 213ES0103X
IL016005811213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine