Provider Demographics
NPI:1043459985
Name:UNIVERSITY FOOT SPECIALISTS LTD
Entity Type:Organization
Organization Name:UNIVERSITY FOOT SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZYGMUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-983-5694
Mailing Address - Street 1:552 S WASHINGTON ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6658
Mailing Address - Country:US
Mailing Address - Phone:630-983-5694
Mailing Address - Fax:630-983-5632
Practice Address - Street 1:552 S WASHINGTON ST
Practice Address - Street 2:SUITE 116
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6658
Practice Address - Country:US
Practice Address - Phone:630-983-5694
Practice Address - Fax:630-983-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003250213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6231430001Medicare NSC