Healthcare Provider Details

I. General information

NPI: 1063615557
Provider Name (Legal Business Name): PROFESSIONAL FOOT CARE SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 S CICERO AVE SUITE 103
CHICAGO IL
60632-4967
US

IV. Provider business mailing address

5241 S CICERO AVE SUITE 103
CHICAGO IL
60632-4967
US

V. Phone/Fax

Practice location:
  • Phone: 773-284-8811
  • Fax: 773-284-6431
Mailing address:
  • Phone: 773-284-8811
  • Fax: 773-284-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW GEORGE GAROUFALIS
Title or Position: PRESIDENT
Credential: DPM
Phone: 773-284-8811