Provider Demographics
NPI:1679693865
Name:MIDWEST PODIATRY SERVICES LTD
Entity Type:Organization
Organization Name:MIDWEST PODIATRY SERVICES LTD
Other - Org Name:WEIL FOOT AND ANKLE INSTITUTE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIL, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-390-7666
Mailing Address - Street 1:1660 FEEHANVILLE DR STE 450
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6023
Mailing Address - Country:US
Mailing Address - Phone:847-250-9629
Mailing Address - Fax:847-390-9345
Practice Address - Street 1:610 S MAPLE AVE
Practice Address - Street 2:SUITE 2550
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304
Practice Address - Country:US
Practice Address - Phone:847-390-7666
Practice Address - Fax:847-390-9345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEIL FOOT AND ANKLE INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-30
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60015152OtherBCBS OF IL PROVIDER ID
IL=========OtherFEIN
IL768400Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL=========OtherFEIN
ILCA0918Medicare PIN