Healthcare Provider Details

I. General information

NPI: 1023297470
Provider Name (Legal Business Name): COMPLETE ANKLE AND FOOT, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 W CHICAGO AVE SUITE 8
CHICAGO IL
60622-5512
US

IV. Provider business mailing address

1802 W CHICAGO AVE SUITE 8
CHICAGO IL
60622-5512
US

V. Phone/Fax

Practice location:
  • Phone: 773-227-3080
  • Fax: 773-227-3762
Mailing address:
  • Phone: 773-227-3080
  • Fax: 773-227-3762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005196
License Number StateIL

VIII. Authorized Official

Name: DR. ELIZABETH ANNE KURTZ
Title or Position: OWNER
Credential: DPM
Phone: 773-227-3080