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Organization
EVANSTON PODIATRY CENTER
Active
Organization
EVANSTON PODIATRY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR & CEO)
(847) 424-9888
Entity
Organization
Contact information
Practice address
1605 CHICAGO AVE, EVANSTON, IL 60201-4504
(847) 424-9888
(847) 424-9649
Mailing address
9933 S WESTERN AVE, SUITE 102, CHICAGO, IL 60643-1810
(847) 424-9888
(847) 424-9649
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
IL
213EP0504X
Public Medicine Podiatrist
—
IL
213EP1101X
Primary Podiatric Medicine Podiatrist
—
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
IL
213ES0131X
Foot Surgery Podiatrist
—
IL
Other
Enumeration date
08/19/2005
Last updated
07/03/2008
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