Provider Demographics
NPI:1184184186
Name:FOOT & ANKLE HEALTH CARE CENTER LTD
Entity type:Organization
Organization Name:FOOT & ANKLE HEALTH CARE CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-205-0106
Mailing Address - Street 1:5501 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4130
Mailing Address - Country:US
Mailing Address - Phone:773-205-0107
Mailing Address - Fax:312-259-5972
Practice Address - Street 1:5950 HOHMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-2424
Practice Address - Country:US
Practice Address - Phone:219-501-0115
Practice Address - Fax:773-205-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies