Provider Demographics
NPI:1689736985
Name:FOOT CARE CONSULTANTS
Entity Type:Organization
Organization Name:FOOT CARE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-283-6200
Mailing Address - Street 1:5511 1/2 W MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1331
Mailing Address - Country:US
Mailing Address - Phone:773-283-6200
Mailing Address - Fax:773-283-7578
Practice Address - Street 1:5511 1/2 W MONTROSE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1331
Practice Address - Country:US
Practice Address - Phone:773-283-6200
Practice Address - Fax:773-283-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003003213E00000X
IL0160033252213E00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003003Medicaid
IL016003252Medicaid
IL016003003Medicaid
IL016003252Medicaid
T37296Medicare UPIN
T37730Medicare UPIN