Healthcare Provider Details

I. General information

NPI: 1902072309
Provider Name (Legal Business Name): LOUIS J. SANFILIPPO D.P.M. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 W LAKE ST SUITE 16
ADDISON IL
60101-5744
US

IV. Provider business mailing address

1250 W LAKE ST SUITE 16
ADDISON IL
60101-5744
US

V. Phone/Fax

Practice location:
  • Phone: 630-543-3000
  • Fax: 630-543-5910
Mailing address:
  • Phone: 630-543-3000
  • Fax: 630-543-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0016-2814
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LOUIS JEROME SANFILIPPO
Title or Position: OWNER/PRESIDENT
Credential: D.P.M.
Phone: 630-543-3000