Basic Information
| Provider Information | |||||||||
| NPI: | 1497878920 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARKWEST PODIATRY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 W DIVERSEY PKWY | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606141454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732813563 | ||||||||
| FaxNumber: | 7735492178 | ||||||||
| Practice Location | |||||||||
| Address1: | 2875 W 19TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606233501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735211710 | ||||||||
| FaxNumber: | 7735492178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | METZ | ||||||||
| AuthorizedOfficialFirstName: | SLOAN | ||||||||
| AuthorizedOfficialMiddleName: | V. | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7732813563 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 016004617 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.