Provider Demographics
NPI:1275770844
Name:GODFREY V. VIEGAS DPM, FOOT AND ANKLE CENTER, INC.
Entity Type:Organization
Organization Name:GODFREY V. VIEGAS DPM, FOOT AND ANKLE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GODFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-356-0500
Mailing Address - Street 1:280 MEMORIAL CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6233
Mailing Address - Country:US
Mailing Address - Phone:815-356-0500
Mailing Address - Fax:815-356-0539
Practice Address - Street 1:280 MEMORIAL CT
Practice Address - Street 2:SUITE C
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6233
Practice Address - Country:US
Practice Address - Phone:815-356-0500
Practice Address - Fax:815-356-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004459213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2051Medicare PIN
ILIL2050Medicare PIN