Healthcare Provider Details

I. General information

NPI: 1457674566
Provider Name (Legal Business Name): ACCREDITED FOOT SURGEONS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17728 OAK PARK AVE STE A
TINLEY PARK IL
60477-2063
US

IV. Provider business mailing address

17728 OAK PARK AVE STE A
TINLEY PARK IL
60477-2063
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-5252
  • Fax: 708-429-5981
Mailing address:
  • Phone: 708-429-5252
  • Fax: 708-429-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016-003064
License Number StateIL

VIII. Authorized Official

Name: DR. GARY J THOMAS
Title or Position: PRESIDENT-PROVIDER
Credential: D.P.M.
Phone: 708-429-5252