Healthcare Provider Details

I. General information

NPI: 1902194673
Provider Name (Legal Business Name): AMBULATORY MEDICAL LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24103 W LOCKPORT ST STE 103 SUITE 103
PLAINFIELD IL
60544-1722
US

IV. Provider business mailing address

24103 W LOCKPORT ST STE 103 SUITE 103
PLAINFIELD IL
60544-1722
US

V. Phone/Fax

Practice location:
  • Phone: 773-326-5504
  • Fax:
Mailing address:
  • Phone: 773-326-5504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number060010605
License Number StateIL

VIII. Authorized Official

Name: DR. LUAN SEIKO
Title or Position: PRESIDENT
Credential: DPM
Phone: 773-326-5504