Provider Demographics
NPI:1912299926
Name:NIETUPSKI, KATARZYNA (DPM)
Entity type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:
Last Name:NIETUPSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5485 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1249
Mailing Address - Country:US
Mailing Address - Phone:773-763-6655
Mailing Address - Fax:773-763-5117
Practice Address - Street 1:5485 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1249
Practice Address - Country:US
Practice Address - Phone:773-763-6655
Practice Address - Fax:773-763-5117
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005453213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist