Provider Demographics
NPI:1184830697
Name:VITTORI FOOT & ANKLE SPECIALIST INC
Entity Type:Organization
Organization Name:VITTORI FOOT & ANKLE SPECIALIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VITTORI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-562-7898
Mailing Address - Street 1:15772 S BELL RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8400
Mailing Address - Country:US
Mailing Address - Phone:708-301-4443
Mailing Address - Fax:708-301-4413
Practice Address - Street 1:15772 S BELL RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8400
Practice Address - Country:US
Practice Address - Phone:708-301-4443
Practice Address - Fax:708-301-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005195213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDG0520OtherRAILROAD MEDICARE
217019Medicare PIN
IL5914500001Medicare NSC