Provider Demographics
NPI:1104858984
Name:AMERICAN HOME PODIATRY LTD. INC.
Entity Type:Organization
Organization Name:AMERICAN HOME PODIATRY LTD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUVISON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-590-5606
Mailing Address - Street 1:1116 W NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-2214
Mailing Address - Country:US
Mailing Address - Phone:857-590-5606
Mailing Address - Fax:847-590-5609
Practice Address - Street 1:1116 W NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-2214
Practice Address - Country:US
Practice Address - Phone:857-590-5606
Practice Address - Fax:847-590-5609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNCE1448OtherPALMETTO
TN3352553Medicaid
TN3352553Medicaid