Provider Demographics
NPI:1588631857
Name:METRO FOOT AND ANKLE CENTER, P.C.
Entity Type:Organization
Organization Name:METRO FOOT AND ANKLE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIGAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-910-1120
Mailing Address - Street 1:1400 PINE COVE CT
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4999
Mailing Address - Country:US
Mailing Address - Phone:630-910-1120
Mailing Address - Fax:
Practice Address - Street 1:7530 WOODWARD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-04
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004923213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5333870001Medicare NSC
ILU88234Medicare UPIN
IL210299Medicare ID - Type Unspecified