1316030943 NPI number — NORTHWEST PODIATRY CENTER, LTD

Table of content: DR. DANA MARIE ROBERTS DO (NPI 1659021525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316030943 NPI number — NORTHWEST PODIATRY CENTER, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST PODIATRY CENTER, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316030943
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 WARRENVILLE RD STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEATON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60189-6379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-668-8277
Provider Business Mailing Address Fax Number:
630-668-3358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 WARRENVILLE RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEATON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60189-6379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-668-8277
Provider Business Practice Location Address Fax Number:
630-668-3358
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRYNICZKA
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
630-668-8277

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  162778 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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