Provider Demographics
NPI:1952600058
Name:LAFONTANT, MAGDALA DANIELLE (DPM)
Entity type:Individual
Prefix:DR
First Name:MAGDALA
Middle Name:DANIELLE
Last Name:LAFONTANT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6374 N LINCOLN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1283
Mailing Address - Country:US
Mailing Address - Phone:636-279-1900
Mailing Address - Fax:636-279-1013
Practice Address - Street 1:6374 N LINCOLN AVE STE 205
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1283
Practice Address - Country:US
Practice Address - Phone:773-866-9800
Practice Address - Fax:773-866-1733
Is Sole Proprietor?:No
Enumeration Date:2011-03-15
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005805213EP1101X
MO2011032463213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine