Provider Demographics
NPI:1730185786
Name:VALDES, ANGELES M (DPM)
Entity type:Individual
Prefix:DR
First Name:ANGELES
Middle Name:M
Last Name:VALDES
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 1:3632 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4715
Mailing Address - Country:US
Mailing Address - Phone:773-248-4111
Mailing Address - Fax:773-248-4111
Practice Address - Street 1:3632 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4715
Practice Address - Country:US
Practice Address - Phone:773-248-4111
Practice Address - Fax:773-248-4111
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2024-08-05
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
IL016003592213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003592Medicaid
IL208517 GROUP #Medicare ID - Type UnspecifiedPODIATRY
IL016003592Medicaid