Provider Demographics
NPI:1700292711
Name:ARCHER FOOT CLINIC
Entity type:Organization
Organization Name:ARCHER FOOT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHOUF
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:773-284-9660
Mailing Address - Street 1:PO BOX 11232
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-0232
Mailing Address - Country:US
Mailing Address - Phone:773-284-9660
Mailing Address - Fax:773-284-9676
Practice Address - Street 1:3113 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6223
Practice Address - Country:US
Practice Address - Phone:773-284-9660
Practice Address - Fax:773-284-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty