Active NPI
DRS. Mattana and Kwiecinski
- Foot & Ankle Surgery Podiatrist
- Vernon Hills, IL
National Provider Identifier
1104998780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- 016004013
- Legal business name
- DRS. MATTANA AND KWIECINSKI
- Practice address
- 250 Center Dr
Suite 201
Vernon Hills, IL 60061-1582 - Phone
- (847) 816-4711
- Fax
- (847) 247-1158
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mary Gail Kwiecinski, D.P.M.
- Title
- Partner
- Phone
- (847) 816-4711
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 016004013 | Primary |
Addresses
Primary practice location
250 Center Dr
Suite 201
Vernon Hills, IL 60061-1582
Mailing address
250 Center Dr
Suite 201
Vernon Hills, IL 60061-1582
Phone (847) 816-4711
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DP7858 | Other | IL | RAILROAD MEDICARE |
| 0004932354 | Other | IL | BLUE CROSS BLUE SHIELD |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Foot & Ankle Surgery Podiatrist
- Vernon Hills, IL
- NPI 1366547234
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1267401600000",
"number": "1104998780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 CENTER DR",
"address_2": "SUITE 201",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "600611582",
"telephone_number": "847-816-4711",
"fax_number": "847-247-1158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 CENTER DR",
"address_2": "SUITE 201",
"city": "VERNON HILLS",
"state": "IL",
"postal_code": "600611582",
"telephone_number": "847-816-4711",
"fax_number": "847-247-1158"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DRS. MATTANA AND KWIECINSKI",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2010-03-01",
"status": "A",
"authorized_official_last_name": "KWIECINSKI",
"authorized_official_first_name": "MARY GAIL",
"authorized_official_title_or_position": "PARTNER",
"authorized_official_telephone_number": "847-816-4711",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.P.M."
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": null,
"license": "016004013",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DP7858",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0004932354",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vernon Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.