Provider Demographics
NPI:1578788550
Name:UNIVERSITY FOOT & ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:UNIVERSITY FOOT & ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZYGMUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-241-1700
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-241-1700
Mailing Address - Fax:630-241-1713
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-241-1700
Practice Address - Fax:630-241-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003250213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT337699Medicare UPIN
IL5485870001Medicare NSC
ILT36979Medicare UPIN