Provider Demographics
NPI:1265537047
Name:SANFILIPPO, LOUIS JEROME (DPM)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JEROME
Last Name:SANFILIPPO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W. LAKE ST.
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101
Mailing Address - Country:US
Mailing Address - Phone:630-543-3000
Mailing Address - Fax:630-543-5910
Practice Address - Street 1:1250 W LAKE ST
Practice Address - Street 2:SUITE 16
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5744
Practice Address - Country:US
Practice Address - Phone:630-543-3000
Practice Address - Fax:630-543-5910
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL162814213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36935Medicare UPIN
IL589850Medicare ID - Type Unspecified