Organization
DISOMMA FOOT & ANKLE CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY M DISOMMA DPM (PRESIDENT)
(708) 383-5554
Entity
Organization
Contact information
Practice address
1100 LAKE ST, STE 248, OAK PARK, IL 60301-1015
(708) 383-5554
(708) 383-9321
Mailing address
1100 LAKE ST, STE 248, OAK PARK, IL 60301-1015
(708) 383-5554
(708) 383-9321
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016004585
IL
213E00000X
Podiatrist
Primary
060007223
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004585
—
IL
Enumeration date
10/04/2005
Last updated
07/17/2013
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