Provider Demographics
NPI:1790538411
Name:COMMONWEALTH FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:COMMONWEALTH FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASCONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:586-725-3444
Mailing Address - Street 1:4650 SOUTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-1836
Mailing Address - Country:US
Mailing Address - Phone:708-424-3201
Mailing Address - Fax:704-424-5001
Practice Address - Street 1:3901 DUTCHMANS LN STE 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4726
Practice Address - Country:US
Practice Address - Phone:502-459-3338
Practice Address - Fax:502-459-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies