Provider Demographics
NPI:1659555688
Name:GINA MARIE BAKIARES DPM, P.C.
Entity Type:Organization
Organization Name:GINA MARIE BAKIARES DPM, P.C.
Other - Org Name:HAPPY FOOT CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKIARES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-852-0888
Mailing Address - Street 1:4236 WHITE BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1251
Mailing Address - Country:US
Mailing Address - Phone:630-852-0888
Mailing Address - Fax:
Practice Address - Street 1:2020 OGDEN AVE.
Practice Address - Street 2:SUITE 140
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-6065
Practice Address - Country:US
Practice Address - Phone:630-851-1329
Practice Address - Fax:630-851-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003316213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003316Medicaid
IL016003316Medicaid
ILT37738Medicare UPIN
IL0275710003Medicare NSC