Provider Demographics
NPI:1962640557
Name:DAVID A GERST DPM SC
Entity Type:Organization
Organization Name:DAVID A GERST DPM SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERST
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-375-7106
Mailing Address - Street 1:2315 E 93RD ST
Mailing Address - Street 2:STE. #419
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3936
Mailing Address - Country:US
Mailing Address - Phone:773-375-7106
Mailing Address - Fax:773-375-1622
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:STE. #419
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3936
Practice Address - Country:US
Practice Address - Phone:773-375-7106
Practice Address - Fax:773-375-1622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6201230001Medicare NSC
INM4000038517Medicare PIN
IL343400Medicare PIN