Provider Demographics
NPI:1588658256
Name:CHICAGO PODIATRIC SURGEONS PC
Entity Type:Organization
Organization Name:CHICAGO PODIATRIC SURGEONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-337-9900
Mailing Address - Street 1:467 W ERIE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-5704
Mailing Address - Country:US
Mailing Address - Phone:312-337-9900
Mailing Address - Fax:312-337-9902
Practice Address - Street 1:467 W ERIE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-5704
Practice Address - Country:US
Practice Address - Phone:312-337-9900
Practice Address - Fax:312-337-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16005134213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
60010789OtherBCBS
IL0581740001Medicare NSC
IL387230Medicare PIN