Provider Demographics
NPI:1558530055
Name:ARMAND R. GASBARRO, DPM
Entity Type:Organization
Organization Name:ARMAND R. GASBARRO, DPM
Other - Org Name:DR. ARMAND R. GASBARRO
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-474-1040
Mailing Address - Street 1:3350 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-3112
Mailing Address - Country:US
Mailing Address - Phone:708-474-1040
Mailing Address - Fax:708-474-1044
Practice Address - Street 1:3350 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3112
Practice Address - Country:US
Practice Address - Phone:708-474-1040
Practice Address - Fax:708-474-1044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-002351213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1261940001Medicare NSC