Provider Demographics
NPI:1760652416
Name:CHICAGO FOOT AND ANKLE PC
Entity Type:Organization
Organization Name:CHICAGO FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-925-5700
Mailing Address - Street 1:5700 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2408
Mailing Address - Country:US
Mailing Address - Phone:773-925-5700
Mailing Address - Fax:773-925-5775
Practice Address - Street 1:5700 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2408
Practice Address - Country:US
Practice Address - Phone:773-925-5700
Practice Address - Fax:773-925-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD08726OtherRAILROAD MEDICARE
IL01638903OtherBLUE CROSS BLUE SHIELD
ILD08726OtherRAILROAD MEDICARE
IL01638903OtherBLUE CROSS BLUE SHIELD