Healthcare Provider Details

I. General information

NPI: 1598508186
Provider Name (Legal Business Name): ELMHURST FOOT & ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 W 1ST ST
ELMHURST IL
60126-2815
US

IV. Provider business mailing address

183 W 1ST ST
ELMHURST IL
60126-2815
US

V. Phone/Fax

Practice location:
  • Phone: 630-530-3338
  • Fax:
Mailing address:
  • Phone: 630-530-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DEEP N SHAH
Title or Position: CO-OWNER
Credential: DPM, MBA
Phone: 518-330-7689