Healthcare Provider Details

I. General information

NPI: 1134802739
Provider Name (Legal Business Name): ABSOLUTE FOOT AND ANKLE SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/19/2023
Certification Date: 08/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8208 CRESTVIEW DR
WILLOW SPRINGS IL
60480-1010
US

IV. Provider business mailing address

8208 CRESTVIEW DR
WILLOW SPRINGS IL
60480-1010
US

V. Phone/Fax

Practice location:
  • Phone: 708-630-2017
  • Fax: 708-398-9777
Mailing address:
  • Phone: 312-925-8207
  • Fax: 708-398-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER CKLAMOVSKI
Title or Position: SOLE MBR PHYSICIAN
Credential: MD
Phone: 312-925-8207