Provider Demographics
NPI:1720037138
Name:PREFERRED PODIATRY GROUP PC
Entity Type:Organization
Organization Name:PREFERRED PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/AO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-627-2924
Mailing Address - Street 1:PO BOX 772294
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-0917
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:844-443-0082
Practice Address - Street 1:168 N CLINTON ST FL 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1425
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:847-504-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKDW2909OtherRAILROAD MEDICARE
IADX1124OtherRAILROAD MEDICARE
IL060005901Medicaid
TXDR6817OtherRAILROAD MEDICARE
MO504482407Medicaid
KY7100257260Medicaid
ILC12116OtherRAILROAD MEDICARE
WICB3726OtherRAILROAD MEDICARE
TNQ030004Medicaid
WI43265500Medicaid
CO73780081Medicaid
INCH4840OtherRAILROAD MEDICARE
CODW2427OtherRAILROAD MEDICARE
IA1720037138Medicaid
OK200623610AMedicaid
MODS6430OtherRAILROAD MEDICARE
IN100253080EMedicaid
TX281333901Medicaid
KYDU2423OtherRAILROAD MEDICARE
INCH4840OtherRAILROAD MEDICARE
TXDR6817OtherRAILROAD MEDICARE
IA1720037138Medicaid
KY7100257260Medicaid
TXTXB100281Medicare PIN
MODS6430OtherRAILROAD MEDICARE
OKDW2909OtherRAILROAD MEDICARE
WICB3726OtherRAILROAD MEDICARE
OK200623610AMedicaid
KY7100257260Medicaid
WI81435Medicare PIN
TXTXB100281Medicare PIN
TXTXB164718Medicare PIN
MO000014962Medicare PIN
TX2813339Medicaid
IN859800Medicare PIN
IL560770Medicare PIN
IL560760Medicare PIN
MO000014963Medicare PIN