Provider Demographics
NPI:1801980255
Name:CHICAGO FOOT HEALTH CENTERS, LLC
Entity type:Organization
Organization Name:CHICAGO FOOT HEALTH CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIELY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-296-7160
Mailing Address - Street 1:3000 N. HALSTED
Mailing Address - Street 2:301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-296-7160
Mailing Address - Fax:773-296-3440
Practice Address - Street 1:3000 N. HALSTED
Practice Address - Street 2:301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:773-296-7160
Practice Address - Fax:773-296-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623520OtherBCBS 1623520
IL1623520OtherBCBS 1623520
ILT37004Medicare UPIN
IL1623520OtherBCBS 1623520
IL=========OtherTIN
ILT36992Medicare UPIN
ILV02334Medicare UPIN