Provider Demographics
NPI:1639389612
Name:ASHLEY A KEREN DPM PC
Entity Type:Organization
Organization Name:ASHLEY A KEREN DPM PC
Other - Org Name:HAPPY FEET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KEREN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-415-2840
Mailing Address - Street 1:1215 MCHENRY RD
Mailing Address - Street 2:SUITE 130A
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1388
Mailing Address - Country:US
Mailing Address - Phone:847-415-2840
Mailing Address - Fax:847-215-2841
Practice Address - Street 1:1215 MCHENRY RD
Practice Address - Street 2:SUITE 130A
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1388
Practice Address - Country:US
Practice Address - Phone:847-415-2840
Practice Address - Fax:847-415-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005237213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6009001Medicaid
IL6014450001Medicare NSC
IL215399Medicare PIN
IL=========6009001Medicaid