Provider Demographics
NPI:1588206262
Name:PREFERRED PODIATRY GROUP OF KANSAS LLC
Entity Type:Organization
Organization Name:PREFERRED PODIATRY GROUP OF KANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-504-5007
Mailing Address - Street 1:40 SKOKIE BLVD STE 520
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1601
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:
Practice Address - Street 1:168 N CLINTON ST FL 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1425
Practice Address - Country:US
Practice Address - Phone:847-502-4898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-14
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty