Provider Demographics
NPI:1336186840
Name:CHICAGO PODIATRY SERVICES, P.C.
Entity Type:Organization
Organization Name:CHICAGO PODIATRY SERVICES, P.C.
Other - Org Name:CHATHAM FOOT SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-978-3338
Mailing Address - Street 1:8751 S GREENWOOD AVE
Mailing Address - Street 2:#108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7051
Mailing Address - Country:US
Mailing Address - Phone:773-978-3338
Mailing Address - Fax:773-978-4606
Practice Address - Street 1:8751 S GREENWOOD AVE
Practice Address - Street 2:#108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7051
Practice Address - Country:US
Practice Address - Phone:773-978-3338
Practice Address - Fax:773-978-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1633823OtherBLUE CROSS BLUE SHIELD
601015700OtherDEPARTMENT OF LABOR
DA8100OtherRAILROAD MEDICARE NUMBER
IL208126Medicare PIN
IL5090350001Medicare NSC