Healthcare Provider Details

I. General information

NPI: 1689652570
Provider Name (Legal Business Name): FAMILY PODIATRY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BROM CT STE 201
NAPERVILLE IL
60540-6534
US

IV. Provider business mailing address

720 BROM CT STE 201
NAPERVILLE IL
60540-6534
US

V. Phone/Fax

Practice location:
  • Phone: 630-355-3668
  • Fax: 630-355-3016
Mailing address:
  • Phone: 630-355-3668
  • Fax: 630-355-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE M KOSOVA
Title or Position: OWNER
Credential: DPM
Phone: 630-355-3668