# POTACH-MOON PODIATRY GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PM Podiatry Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679957914
- **Authorized official:** DR. LUIS E MENDOZA DPM (PRESIDENT)
- **Authorized official phone:** (708) 780-8661

## Contact information

- **Practice address:** 5610 W CERMAK RD UNIT 2, CICERO, IL 60804-2219
- **Practice address phone:** (708) 780-8661
- **Practice address fax:** (708) 780-9537
- **Mailing address:** 5610 W CERMAK RD UNIT 2, CICERO, IL 60804-2219
- **Mailing address phone:** (708) 780-8661
- **Mailing address fax:** (708) 780-9537

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 07/16/2015
- **Last updated:** 01/05/2019