Provider Demographics
NPI:1467676536
Name:AAA FOOT & ANKLE ASSOCIATES
Entity Type:Organization
Organization Name:AAA FOOT & ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-328-3338
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE #469
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-328-3338
Mailing Address - Fax:847-328-3388
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE#469
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-328-3338
Practice Address - Fax:847-328-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003961213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207208Medicare PIN
IL207204Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER