Provider Demographics
NPI:1407002298
Name:SCHAUMBURG PODIATRY CENTER, INC
Entity Type:Organization
Organization Name:SCHAUMBURG PODIATRY CENTER, INC
Other - Org Name:SCHAUMBURG FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-834-3668
Mailing Address - Street 1:11 E SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3501
Mailing Address - Country:US
Mailing Address - Phone:847-985-8380
Mailing Address - Fax:847-985-9475
Practice Address - Street 1:11 E SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3501
Practice Address - Country:US
Practice Address - Phone:847-985-8380
Practice Address - Fax:847-985-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6237250001Medicare NSC