DR. MALCOLM DUGRO HERZOG D.P.M. NPI 1356450415

NPI Information

NPI: 1356450415
Provider Name: DR. MALCOLM DUGRO HERZOG, D.P.M.
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

Address:
5241 S CICERO AVE
SUITE 103
CHICAGO, IL
ZIP 60632
Phone: (773) 284-8811
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DR. Malcolm Dugro Herzog, D.P.M. is a foot and ankle surgery podiatrist in Chicago, IL. DR. Malcolm Dugro Herzog, D.P.M. NPI is 1356450415. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5241 S CICERO AVE
SUITE 103
CHICAGO, IL
ZIP 60632-967
Phone: (773) 284-8811
Fax: (773) 284-6431

The enumeration date for this NPI number is 8/30/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery		ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	60001221	OTHER	ILLINOIS	BC& BS PROVIDER #
2	K16764	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	DUPAGE PROVIDER NUMBER
3	T37671	MEDICARE UPIN	ILLINOIS
4	211512	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	GROUP COOK COUNTY
5	211509	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	GROUP DUPAGE COUNTY
6	K16735	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS	COOK - PROVIDER #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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