Provider Demographics
NPI:1093944522
Name:FOOT & ANKLE PHYSICIANS GROUP, PC
Entity Type:Organization
Organization Name:FOOT & ANKLE PHYSICIANS GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-282-3377
Mailing Address - Street 1:5012 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3822
Mailing Address - Country:US
Mailing Address - Phone:773-282-3377
Mailing Address - Fax:773-205-4439
Practice Address - Street 1:5012 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3822
Practice Address - Country:US
Practice Address - Phone:773-282-3377
Practice Address - Fax:773-205-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005305213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01600112OtherBCBS
IL6341340001Medicare NSC
ILIL2629Medicare PIN