Provider Demographics
NPI:1891828075
Name:MIDWEST FOOT & ANKLE CLINICS
Entity Type:Organization
Organization Name:MIDWEST FOOT & ANKLE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S. KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-398-8637
Mailing Address - Street 1:880 W CENTRAL RD
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:ARLINGTON HEIGTHS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2368
Mailing Address - Country:US
Mailing Address - Phone:847-398-8637
Mailing Address - Fax:847-398-4349
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 3500
Practice Address - City:ARLINGTON HEIGTHS
Practice Address - State:IL
Practice Address - Zip Code:60005-2368
Practice Address - Country:US
Practice Address - Phone:847-398-8637
Practice Address - Fax:847-398-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004842213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004842Medicaid
IL216344Medicare PIN
IL6258180002Medicare NSC