Provider Demographics
NPI:1689098766
Name:ESMAILI, TARGOL CHRISTIE (BS, DPM)
Entity Type:Individual
Prefix:DR
First Name:TARGOL
Middle Name:CHRISTIE
Last Name:ESMAILI
Suffix:
Gender:F
Credentials:BS, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 N NORTH BRANCH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2473
Mailing Address - Country:US
Mailing Address - Phone:312-255-8030
Mailing Address - Fax:847-789-7202
Practice Address - Street 1:1229 N NORTH BRANCH ST
Practice Address - Street 2:STE 308
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-2496
Practice Address - Country:US
Practice Address - Phone:312-255-8030
Practice Address - Fax:847-789-7202
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP88854213ES0103X
IL016.005696213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery