Provider Demographics
NPI:1366436131
Name:WRAY, JOHN M (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:WRAY
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1129
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-372-0919
Mailing Address - Fax:312-373-1606
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1129
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-372-0919
Practice Address - Fax:312-373-1606
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL016002772213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL598830Medicare ID - Type UnspecifiedDOWNERS GROVE OFFICE
ILT36928Medicare UPIN
IL598960Medicare ID - Type UnspecifiedCHICAGO OFFICE
IL5407160001Medicare NSC