Provider Demographics
NPI:1023334935
Name:ADVANCED FOOT & ANKLE SPECIALISTS SC
Entity type:Organization
Organization Name:ADVANCED FOOT & ANKLE SPECIALISTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:OCHWAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-698-3637
Mailing Address - Street 1:1750 N RANDALL RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-7900
Mailing Address - Country:US
Mailing Address - Phone:630-698-3637
Mailing Address - Fax:
Practice Address - Street 1:1750 N RANDALL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7900
Practice Address - Country:US
Practice Address - Phone:630-698-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005296213ES0103X
IL01600357213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7477270001Medicare NSC