Provider Demographics
NPI:1215067806
Name:SPACCAPANICCIA PODIATRY LTD PC
Entity type:Organization
Organization Name:SPACCAPANICCIA PODIATRY LTD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CKLAMOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-495-3338
Mailing Address - Street 1:2340 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5371
Mailing Address - Country:US
Mailing Address - Phone:630-495-3338
Mailing Address - Fax:
Practice Address - Street 1:2340 S HIGHLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-7131
Practice Address - Country:US
Practice Address - Phone:630-495-3338
Practice Address - Fax:630-495-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003407213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0060015180OtherBCBS
ILCN8416OtherMEDICARE RAILROAD
0Other1
IL0060015182OtherBCBS
ILCN8416OtherMEDICARE RAILROAD
IL0060015182OtherBCBS