MEDICARE: ATA HEALTH SYSTEMS, INC.

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	213ES0103X	Foot & Ankle Surgery Podiatrist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60001189	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1992916969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATA HEALTH SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	175 N HARBOR DR
Second Line	:	SUITE 3906
City	:	CHICAGO
State	:	IL
Zip	:	60601-7344
Country	:	US
Telephone Number	:	773-978-2100
Fax Number	:	773-978-1568

Provider Business Practice Location Address
First Line	:	175 N HARBOR DR
Second Line	:	SUITE 3906
City	:	CHICAGO
State	:	IL
Zip	:	60601-7344
Country	:	US
Telephone Number	:	773-978-2100
Fax Number	:	773-978-1568

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER AKERELE
Credential	:	DPM
Telephone Number	:	773-978-2100

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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Directions to “ATA HEALTH SYSTEMS, INC. ” Practice Location

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