Provider Demographics
NPI:1447360532
Name:MICHAEL A. WOOD, D.P.M., P.C.
Entity type:Organization
Organization Name:MICHAEL A. WOOD, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-418-5551
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-0049
Mailing Address - Country:US
Mailing Address - Phone:708-895-9000
Mailing Address - Fax:708-418-0916
Practice Address - Street 1:10528 S EWING AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-6219
Practice Address - Country:US
Practice Address - Phone:773-375-0791
Practice Address - Fax:773-734-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060009368213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212509Medicare PIN
IN189340Medicare PIN
IN189330Medicare PIN