Individual
SAMUEL VINCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
303 W OGDEN AVE FL 2, WESTMONT, IL 60559-1419
(630) 510-6929
(630) 355-3273
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003414
IL
213EP1101X
Primary Podiatric Medicine Podiatrist
016003414
IL
213ES0000X
Sports Medicine Podiatrist
016003414
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
016003414
IL
213ES0131X
Foot Surgery Podiatrist
016003414
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003414
—
IL
01
—
480007268
RAILROAD MEDICARE
IL
Enumeration date
09/27/2005
Last updated
08/28/2023
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