Organization
GOLD COAST PODIATRY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FORTUNEE MASSUDA DPM (MEDICAL DIRECTOR & CEO)
(312) 280-7886
Entity
Organization
Contact information
Practice address
750 N FRANKLIN ST, SUITE 102, CHICAGO, IL 60654-6263
(312) 280-7886
(312) 280-9547
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
—
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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016-23607
BCBS
IL
Enumeration date
08/19/2005
Last updated
04/22/2013
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