Provider Demographics
NPI:1043389703
Name:CYNTHIA A SINK DPM FACFAS SC
Entity Type:Organization
Organization Name:CYNTHIA A SINK DPM FACFAS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM FACFAS SC
Authorized Official - Phone:708-301-5600
Mailing Address - Street 1:10760 W 143RD ST
Mailing Address - Street 2:STE 60
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1913
Mailing Address - Country:US
Mailing Address - Phone:708-301-5600
Mailing Address - Fax:708-301-5602
Practice Address - Street 1:10760 W 143RD ST
Practice Address - Street 2:STE 60
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1913
Practice Address - Country:US
Practice Address - Phone:708-301-5600
Practice Address - Fax:708-301-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004273213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-004273OtherLICENSE
IL016-004273OtherLICENSE
IL4503170001Medicare NSC