Basic Information
| Provider Information | |||||||||
| NPI: | 1639250632 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANSYN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 E ARMY TRAIL RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601082169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308933668 | ||||||||
| FaxNumber: | 6308933670 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 E ARMY TRAIL RD | ||||||||
| Address2: | SUITE # 101 | ||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601082169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308933668 | ||||||||
| FaxNumber: | 6308933670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 01/09/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 016-003968 | IL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | 016-003968 | IL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.