Provider Demographics
NPI:1841582467
Name:FAMILY FOOT AND ANKLE SURGEONS OF ILLINOIS, LLC
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE SURGEONS OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HYIM
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:BARONOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-368-8493
Mailing Address - Street 1:3170 N SHERIDAN RD APT 622
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0917
Mailing Address - Country:US
Mailing Address - Phone:773-368-8493
Mailing Address - Fax:
Practice Address - Street 1:401 GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-5744
Practice Address - Country:US
Practice Address - Phone:847-662-0978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty