Provider Demographics
NPI:1477679397
Name:LAKE ZURICH PODIATRY PC
Entity Type:Organization
Organization Name:LAKE ZURICH PODIATRY PC
Other - Org Name:LAKE ZURICH FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SOSINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-540-0234
Mailing Address - Street 1:950 W MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3417
Mailing Address - Country:US
Mailing Address - Phone:847-540-0234
Mailing Address - Fax:847-540-0867
Practice Address - Street 1:950 W MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3417
Practice Address - Country:US
Practice Address - Phone:847-540-0234
Practice Address - Fax:847-540-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003263213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDG9348OtherRAILROAD MEDICARE GROUP PTAN
04927332OtherBLUE CROSS BLUE SHIELD
480001414OtherRAILROAD MEDICARE PTAN
ILDG9348OtherRAILROAD MEDICARE GROUP PTAN
480001414OtherRAILROAD MEDICARE PTAN