Provider Demographics
NPI:1821099276
Name:HETTINGER, DAVID F (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:HETTINGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 APPALOOSA CT W
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8922
Mailing Address - Country:US
Mailing Address - Phone:630-682-3338
Mailing Address - Fax:630-682-5836
Practice Address - Street 1:59 DANADA SQ E
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-8484
Practice Address - Country:US
Practice Address - Phone:630-682-3338
Practice Address - Fax:630-682-5836
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003842213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363842498OtherCORPORATE TAX ID
IL211992Medicare PIN
IL363842498OtherCORPORATE TAX ID
ILT37308Medicare UPIN