Healthcare Provider Details

I. General information

NPI: 1306114236
Provider Name (Legal Business Name): SKOKIE FOOT & ANKLE SPECIALISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9933 LAWLER AVE SUITE 315
SKOKIE IL
60077-3703
US

IV. Provider business mailing address

9933 LAWLER AVE SUITE 315
SKOKIE IL
60077-3703
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-3400
  • Fax: 847-725-0070
Mailing address:
  • Phone: 847-675-3400
  • Fax: 847-725-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016-004990
License Number StateIL

VIII. Authorized Official

Name: DR. STEVEN B. MILLER
Title or Position: PRESIDENT
Credential:
Phone: 773-425-4613