Organization
DEZANEK PODIATRY CENTER LTD
Active
Other names
Robert C Dezanek DPM
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT CHARLES DEZANEK DPM (CORP PRESIDENT)
(773) 283-1911
Entity
Organization
Contact information
Practice address
5916 W HIGGINS AVE, CHICAGO, IL 60630-1905
(773) 283-1911
Mailing address
5916 W HIGGINS AVE, CHICAGO, IL 60630-1905
(773) 283-1911
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003970
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060001570
BLUE CROSS
IL
05
—
3394649896063002
—
IL
01
—
480009595
RAILROAD MEDICARE
IL
Enumeration date
11/01/2006
Last updated
12/26/2014
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