Provider Demographics
NPI:1407639263
Name:NORTH SUBURBAN FOOT AND ANKLE CENTER PLLC
Entity Type:Organization
Organization Name:NORTH SUBURBAN FOOT AND ANKLE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-991-1262
Mailing Address - Street 1:400 NORTHPOINTE CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7867
Mailing Address - Country:US
Mailing Address - Phone:724-991-1262
Mailing Address - Fax:
Practice Address - Street 1:400 NORTHPOINTE CIR STE 102
Practice Address - Street 2:
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7867
Practice Address - Country:US
Practice Address - Phone:724-991-1262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty