Provider Demographics
NPI:1811180326
Name:DYNAMIC FOOT &ANKLE SURGEONS,P C
Entity type:Organization
Organization Name:DYNAMIC FOOT &ANKLE SURGEONS,P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-301-3893
Mailing Address - Street 1:10330 W ROOSEVELT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2571
Mailing Address - Country:US
Mailing Address - Phone:708-632-5612
Mailing Address - Fax:708-632-5601
Practice Address - Street 1:8840 CALUMET AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2545
Practice Address - Country:US
Practice Address - Phone:708-632-5612
Practice Address - Fax:708-632-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5991480001Medicare NSC