Provider Demographics
NPI:1124610225
Name:FEYINTOLU M. BALOGUN, DPM PLLC
Entity type:Organization
Organization Name:FEYINTOLU M. BALOGUN, DPM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEYINTOLU
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-628-4520
Mailing Address - Street 1:2440 S LARAMIE AVE UNIT 50646
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-5147
Mailing Address - Country:US
Mailing Address - Phone:708-628-4520
Mailing Address - Fax:773-847-4467
Practice Address - Street 1:1406 S CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-4520
Practice Address - Country:US
Practice Address - Phone:708-628-4520
Practice Address - Fax:773-847-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty