Provider Demographics
NPI:1689797110
Name:PARKWEST PODIATRY, P.C.
Entity Type:Organization
Organization Name:PARKWEST PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SLOAN
Authorized Official - Middle Name:V
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
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 1:9000 S STONY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3508
Practice Address - Country:US
Practice Address - Phone:773-731-0670
Practice Address - Fax:773-731-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004617213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4865320004Medicare NSC
ILU42451Medicare UPIN
IL203244Medicare PIN