Individual
DR. MALCOLM DUGRO HERZOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
5241 S CICERO AVE, SUITE 103, CHICAGO, IL 60632-4967
(773) 284-8811
(773) 284-6431
Mailing address
5241 S CICERO AVE, SUITE 103, CHICAGO, IL 60632-4967
(773) 284-8811
(773) 284-6431
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60001221
BC& BS PROVIDER #
IL
Enumeration date
08/30/2006
Last updated
07/08/2007
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