POTACH-MOON PODIATRY GROUP, LLC (NPI# 1679957914) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679957914 |
| Entity Type | Organization |
| Organization Name | POTACH-MOON PODIATRY GROUP, LLC |
| Other Organization Name | PM PODIATRY GROUP |
| Practice Address |
5610 W Cermak Rd Unit 2 Cicero IL 60804-2219 |
| Practice Telephone | 7087808661 |
| Practice Fax Number | 7087809537 |
| Mailing Telephone | 7087808661 |
| Mailing Fax Number | 7087809537 |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2019-01-05 |
| Authorized Official Name | DR. LUIS E MENDOZA (PRESIDENT) |
| Authorized Official Telephone | 7087808661 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
Podiatric Medicine & Surgery Service Providers |
| Other Name | Type Code |
|---|---|
| PM Podiatry Group | Doing Business As Name - Organization |
| Street Address |
5610 W CERMAK RD UNIT 2 |
| City | CICERO |
| State | IL |
| Zip Code | 60804-2219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265096945 | Jacqueline N/a Gonzalez | Physical Therapy Assistant | 3521 S 56th Ct, Cicero, IL 60804 | 2019-04-27 |
| 1265966832 | Jacqueline Calles | Substance Abuse Rehabilitation Facility | 4904 W. 32nd St, Cicero, IL 60804 | 2017-04-20 |
| 1346667771 | America's Best Contacts & Eyeglasses | Technician/Technologist | 4741 W Cermak Rd, Cicero, IL 60804 | 2014-03-24 |
| 1538580469 | Jesus Paul Sanchez | Behavioral Analyst | 3100 S. Central Ave, Cicero, IL 60804 | 2013-12-19 |
| 1568712123 | Monil P Shah Dmd PC | Dentist | 5539 W Cermak Road, Cicero, IL 60804 | 2012-09-11 |
| 1699073148 | Lolita Aguinaga | Social Worker | 5341 W. Cermak Road, Cicero, IL 60804 | 2011-03-08 |
| 1699949263 | Anne T Gearhart | Pediatrics | 2307 S Cicero Ave, Chicago, IL 60804 | 2008-04-15 |
| 1437332467 | J S Vitamins and More Inc | Durable Medical Equipment & Medical Supplies | 4785 W Cermatz, Circero, IL 60804 | 2007-12-13 |
| 1427171339 | Barbara J Majchrowski | Optometrist | 5729 W 35th Street, Suite 1east, Cicero, IL 60804 | 2007-04-06 |
| 1124190269 | Gulliume Moor | Psychologist | 6117 West Cermak Road, Cicero, IL 60804 | 2006-11-14 |
| Find all providers in zip 60804 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578610879 | Familymed Centers PC | Podiatrist | 5700 W Cermak Rd, Cicero, IL 60804-2128 | 2007-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154930485 | Mid America Foot & Ankle Specialist Illinois LLC | Podiatrist | 2003 Montgomery Rd Ste 108109, Aurora, IL 60504-9078 | 2020-07-22 |
| 1265040026 | Northern Illinois Foot & Ankle Specialists, Ltd | Podiatrist | 4121 Fairview Ave Ste 102, Downers Grove, IL 60515-2266 | 2020-07-17 |
| 1316563612 | Jacob Tilsley | Podiatrist | 610 S Maple Ave Ste 2250, Oak Park, IL 60304-1093 | 2020-06-22 |
| 1033738547 | C James Anderson Dpm LLC | Podiatrist | 1000 Eleven S Ste 3a, Columbia, IL 62236-1077 | 2020-04-14 |
| 1386263895 | C James Anderson Dpm LLC | Podiatrist | 717 Insight Ave Ste 100, O Fallon, IL 62269-2193 | 2020-04-14 |
| 1821631367 | Dr Christine Heck PC | Podiatrist | 111 N Wabash Ave Ste 1914, Chicago, IL 60602-2968 | 2019-10-28 |
| 1013562578 | Bishoy Atef Botros | Podiatrist | 820 S Damen Ave Fl 7, Chicago, IL 60612-3728 | 2019-08-01 |
| 1538623947 | Steven B Overpeck Dpm PC | Podiatrist | 25520 S Pheasant Ln Unit K, Channahon, IL 60410-8808 | 2019-01-30 |
| 1366916355 | Center for Foot and Ankle Surgery Ltd | Podiatrist | 654 W Veterans Pkwy Ste D, Yorkville, IL 60560-2510 | 2019-01-14 |
| 1497224950 | Northern Illinois Foot & Ankle Specialists, Ltd | Podiatrist | 1288 S Us Highway 12, Fox Lake, IL 60020-1950 | 2018-11-14 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on POTACH-MOON PODIATRY GROUP, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.