Healthcare Provider Details

I. General information

NPI: 1194109314
Provider Name (Legal Business Name): VP FOOT AND ANKLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 S DEARBORN ST
CHICAGO IL
60605-1838
US

IV. Provider business mailing address

730 S DEARBORN ST
CHICAGO IL
60605-1838
US

V. Phone/Fax

Practice location:
  • Phone: 312-588-1104
  • Fax: 312-577-0884
Mailing address:
  • Phone: 312-588-1104
  • Fax: 312-577-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: AARON RAESTAS
Title or Position: DPM
Credential:
Phone: 312-259-6922