Provider Demographics
NPI:1013552074
Name:PODIATRY OF CHICAGO
Entity Type:Organization
Organization Name:PODIATRY OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-255-5004
Mailing Address - Street 1:665 N VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-4193
Mailing Address - Country:US
Mailing Address - Phone:847-255-5004
Mailing Address - Fax:847-255-5073
Practice Address - Street 1:6560 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2161
Practice Address - Country:US
Practice Address - Phone:847-775-0300
Practice Address - Fax:847-775-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty