MEDICARE: FOOT FIRST PODIATRY CENTERS VPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist

General Provider Information

NPI Number	:	1689072308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT FIRST PODIATRY CENTERS VPC

Provider Business Mailing Address
First Line	:	1601 W WISE RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-3554
Country	:	US
Telephone Number	:	847-352-9221
Fax Number	:

Provider Business Practice Location Address
First Line	:	6969 N LINCOLN AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2527
Country	:	US
Telephone Number	:	847-352-9221
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	WINNIE SHUMATE
Credential	:
Telephone Number	:	309-762-9242

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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Directions to “FOOT FIRST PODIATRY CENTERS VPC ” Practice Location

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