Organization
A GOLD COAST FOOT CLINIC, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD C BENNETT II D.P.M. (PRESIDENT)
(312) 266-7404
Entity
Organization
Contact information
Practice address
845 N MICHIGAN AVE, 915W, CHICAGO, IL 60611-2252
(312) 266-7404
(312) 494-9110
Mailing address
845 N MICHIGAN AVE, 915W, CHICAGO, IL 60611-2252
(312) 266-7404
(312) 494-9110
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016-004014
IL
Other
Enumeration date
06/20/2008
Last updated
11/24/2008
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