MEDICARE: BLYUMIN FOOT & ANKLE CLINIC LTD

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	213E00000X	Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881798007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLYUMIN FOOT & ANKLE CLINIC LTD

Provider Business Mailing Address
First Line	:	1405 W. MORSE AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626
Country	:	US
Telephone Number	:	773-743-5100
Fax Number	:	773-743-0932

Provider Business Practice Location Address
First Line	:	1405 W. MORSE AVE.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626
Country	:	US
Telephone Number	:	773-743-5100
Fax Number	:	773-743-0932

Authorized Official
Title or Position	:	DR./OWNER
Name	:	LEONID BLYUMIN
Credential	:	D.P.M.
Telephone Number	:	773-743-5100

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	08/27/2008

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