Provider Demographics
NPI:1235396888
Name:EVANSTON FOOT & ANKLE CLINIC
Entity Type:Organization
Organization Name:EVANSTON FOOT & ANKLE CLINIC
Other - Org Name:DR KEVIN TUNNAT DPM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TUNNAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-328-2282
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE #611
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-864-5010
Mailing Address - Fax:847-864-9632
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE #611
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-864-5010
Practice Address - Fax:847-864-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU12366Medicare UPIN
IL943100Medicare PIN