Organization
MONTROSE FOOT AND ANKLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WIKA K GOMEZ DPM (OWNER)
(773) 528-4700
Entity
Organization
Contact information
Practice address
1929 W MONTROSE AVE, CHICAGO, IL 60613-1011
(773) 528-4700
(773) 529-5392
Mailing address
1929 W MONTROSE AVE, CHICAGO, IL 60613-1011
(773) 528-4700
(773) 529-5392
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016005228
—
IL
Enumeration date
03/23/2009
Last updated
02/12/2010
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