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Organization
NORTHWEST INDIANA PODIATRY CLINIC, LLC
Active
Organization
NORTHWEST INDIANA PODIATRY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR/CEO)
(219) 398-0100
Entity
Organization
Contact information
Practice address
4320 FIR ST, EAST CHICAGO, IN 46312-3052
(219) 398-0100
(219) 398-4192
Mailing address
9933 S WESTERN AVE, SUITE 102, CHICAGO, IL 60643-1810
(773) 233-3800
(773) 233-2513
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
—
IN
213EP0504X
Public Medicine Podiatrist
—
IN
213EP1101X
Primary Podiatric Medicine Podiatrist
—
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
IN
213ES0131X
Foot Surgery Podiatrist
—
IN
Other
Enumeration date
08/19/2005
Last updated
02/20/2014
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