Provider Demographics
NPI:1558886549
Name:CASTLE PODIATRY, LLC
Entity Type:Organization
Organization Name:CASTLE PODIATRY, LLC
Other - Org Name:KEIR FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:KEIR
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-941-4040
Mailing Address - Street 1:11628 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4730
Mailing Address - Country:US
Mailing Address - Phone:773-941-4040
Mailing Address - Fax:773-897-0088
Practice Address - Street 1:11628 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4730
Practice Address - Country:US
Practice Address - Phone:773-941-4040
Practice Address - Fax:738-970-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005587213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty