Provider Demographics
NPI:1417133737
Name:FOOT FIRST PODIATRY CENTERS, V.P.C.
Entity Type:Organization
Organization Name:FOOT FIRST PODIATRY CENTERS, V.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SKLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-352-9221
Mailing Address - Street 1:1601 W WISE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4777 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2273
Practice Address - Country:US
Practice Address - Phone:815-229-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT FIRST PODIATRY CENTERS, V.P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92592Medicare UPIN
IL728402Medicare PIN
IL208454Medicare PIN
T38226Medicare UPIN
U98112Medicare UPIN