Provider Demographics
NPI:1659506053
Name:LITSAS CENTER FOR ADVANCED FOOT CARE INC
Entity Type:Organization
Organization Name:LITSAS CENTER FOR ADVANCED FOOT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LITSAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-588-0250
Mailing Address - Street 1:4705 WILLOW SPRINGS RD
Mailing Address - Street 2:S.E.SUITE
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6145
Mailing Address - Country:US
Mailing Address - Phone:708-588-0250
Mailing Address - Fax:708-588-0256
Practice Address - Street 1:4705 WILLOW SPRINGS RD
Practice Address - Street 2:S.E.SUITE
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6145
Practice Address - Country:US
Practice Address - Phone:708-588-0250
Practice Address - Fax:708-588-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005036213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6247830001Medicare NSC