Provider Demographics
NPI:1689976326
Name:GARY M KAZMER DPM INC
Entity Type:Organization
Organization Name:GARY M KAZMER DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAZMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-378-1000
Mailing Address - Street 1:4103 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4313
Mailing Address - Country:US
Mailing Address - Phone:773-378-1000
Mailing Address - Fax:773-521-4260
Practice Address - Street 1:4103 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4313
Practice Address - Country:US
Practice Address - Phone:773-378-1000
Practice Address - Fax:773-521-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4808Medicare PIN
ILIL4807Medicare PIN
IL6488490003Medicare NSC