Provider Demographics
NPI:1396852224
Name:FOOT CARE GROUP PC
Entity Type:Organization
Organization Name:FOOT CARE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:SHARLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-362-8848
Mailing Address - Street 1:1800 HOLLISTER DR
Mailing Address - Street 2:STE 109
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5265
Mailing Address - Country:US
Mailing Address - Phone:847-362-8848
Mailing Address - Fax:847-362-8860
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:STE 109
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5265
Practice Address - Country:US
Practice Address - Phone:847-362-8848
Practice Address - Fax:847-362-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004103213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T38549Medicare UPIN
781240Medicare ID - Type Unspecified