Provider Demographics
NPI:1457674566
Name:ACCREDITED FOOT SURGEONS LTD
Entity Type:Organization
Organization Name:ACCREDITED FOOT SURGEONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-429-5252
Mailing Address - Street 1:17728 OAK PARK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2063
Mailing Address - Country:US
Mailing Address - Phone:708-429-5252
Mailing Address - Fax:708-429-5981
Practice Address - Street 1:17728 OAK PARK AVE STE A
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2063
Practice Address - Country:US
Practice Address - Phone:708-429-5252
Practice Address - Fax:708-429-5981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003064213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37507Medicare UPIN