Organization
JENNIFER L KALETA DPM, LTD
Active
Other names
Near North Podiatry Centers
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA WALAS (OFFICE MANEGER)
(773) 868-4701
Entity
Organization
Contact information
Practice address
3000 N HALSTED ST STE 625, CHICAGO, IL 60657-5196
(773) 868-4701
(773) 868-4702
Mailing address
1929 W MONTROSE AVE, CHICAGO, IL 60613-1011
(773) 868-4701
(773) 868-4702
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016-004910
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004910
—
IL
01
—
1633808
BC/BS
—
01
—
207100
MEDICARE ID
—
01
—
5048120002
DMERC
IL
Enumeration date
04/15/2008
Last updated
06/30/2011
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