Provider Demographics
NPI:1265877849
Name:WINERMAN, SAMANTHA DOLPH (DPM)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DOLPH
Last Name:WINERMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:DOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:2500 RIDGE AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2455
Mailing Address - Country:US
Mailing Address - Phone:847-475-9030
Mailing Address - Fax:847-475-9031
Practice Address - Street 1:2500 RIDGE AVE
Practice Address - Street 2:STE 110
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2455
Practice Address - Country:US
Practice Address - Phone:847-475-9030
Practice Address - Fax:847-475-9031
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005646213ES0103X
IL135000819213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program