Provider Demographics
NPI:1235384488
Name:MIKLOS FOOT AND ANKLE SPECIALISTS, PC
Entity Type:Organization
Organization Name:MIKLOS FOOT AND ANKLE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIKLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-586-5487
Mailing Address - Street 1:6634 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2408
Mailing Address - Country:US
Mailing Address - Phone:773-586-5487
Mailing Address - Fax:773-586-9523
Practice Address - Street 1:6634 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2408
Practice Address - Country:US
Practice Address - Phone:773-586-5487
Practice Address - Fax:773-586-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003168213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7061150001OtherMEDICARE DME
IL016003168Medicaid
IL653330Medicare PIN
IL7061150001OtherMEDICARE DME
ILT37495Medicare UPIN