Provider Demographics
NPI:1932548500
Name:MEYER, DOMINIK CORNELIUS (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOMINIK
Middle Name:CORNELIUS
Last Name:MEYER
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 1:2222 W DIVISION ST
Mailing Address - Street 2:#105
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2717
Mailing Address - Country:US
Mailing Address - Phone:773-862-3600
Mailing Address - Fax:773-862-5329
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:#105
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-862-3600
Practice Address - Fax:773-862-5329
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005676213ES0103X
IL135000797390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program