Provider Demographics
NPI:1760687966
Name:C & S SHOES
Entity Type:Organization
Organization Name:C & S SHOES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JULECE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-846-6121
Mailing Address - Street 1:1255 S MICHIGAN AVE
Mailing Address - Street 2:902
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3286
Mailing Address - Country:US
Mailing Address - Phone:312-846-6121
Mailing Address - Fax:
Practice Address - Street 1:1255 S MICHIGAN AVE
Practice Address - Street 2:902
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3286
Practice Address - Country:US
Practice Address - Phone:312-846-6121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL55325394332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies