Provider Demographics
NPI:1568543312
Name:PARKWEST PODIATRY,PC
Entity Type:Organization
Organization Name:PARKWEST PODIATRY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SLOAN
Authorized Official - Middle Name:VENISE
Authorized Official - Last Name:METZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-281-3563
Mailing Address - Street 1:830 W DIVERSEY PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1454
Mailing Address - Country:US
Mailing Address - Phone:773-281-3563
Mailing Address - Fax:773-549-2178
Practice Address - Street 1:830 W DIVERSEY PKWY FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1454
Practice Address - Country:US
Practice Address - Phone:773-281-3563
Practice Address - Fax:773-549-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004617213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4865320003Medicare NSC
IL212106Medicare PIN
IL203244Medicare PIN
ILU42451Medicare UPIN