Provider Demographics
NPI:1356458863
Name:EDWARD I RATKOVICH DPM SC
Entity Type:Organization
Organization Name:EDWARD I RATKOVICH DPM SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:I
Authorized Official - Last Name:RATKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-498-2193
Mailing Address - Street 1:111 W MAPLE ST APT 2210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5454
Mailing Address - Country:US
Mailing Address - Phone:312-498-2193
Mailing Address - Fax:312-642-2387
Practice Address - Street 1:10751 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1900
Practice Address - Country:US
Practice Address - Phone:708-460-8688
Practice Address - Fax:708-460-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty