Provider Demographics
NPI:1669650479
Name:JILL H. AUSTIN, DPM
Entity Type:Organization
Organization Name:JILL H. AUSTIN, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST, SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-535-0360
Mailing Address - Street 1:14810 CICERO AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-1400
Mailing Address - Country:US
Mailing Address - Phone:708-535-0360
Mailing Address - Fax:708-535-3091
Practice Address - Street 1:14810 CICERO AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1400
Practice Address - Country:US
Practice Address - Phone:708-535-0360
Practice Address - Fax:708-535-3091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004325261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5041970001Medicare NSC
ILU12129Medicare UPIN
IL942650Medicare PIN