Provider Demographics
NPI:1245578715
Name:CHICAGO FOOT & ORTHOPEDIC CLINIC, LTD
Entity Type:Organization
Organization Name:CHICAGO FOOT & ORTHOPEDIC CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHOUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-284-9660
Mailing Address - Street 1:PO BOX 11232
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-0232
Mailing Address - Country:US
Mailing Address - Phone:773-284-9660
Mailing Address - Fax:773-284-9676
Practice Address - Street 1:3918 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4604
Practice Address - Country:US
Practice Address - Phone:773-284-9660
Practice Address - Fax:773-284-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical