Healthcare Provider Details

I. General information

NPI: 1184184186
Provider Name (Legal Business Name): FOOT & ANKLE HEALTH CARE CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 HOHMAN AVE
HAMMOND IN
46320-2424
US

IV. Provider business mailing address

5501 W BELMONT AVE
CHICAGO IL
60641-4130
US

V. Phone/Fax

Practice location:
  • Phone: 219-501-0115
  • Fax: 773-205-8107
Mailing address:
  • Phone: 773-205-0107
  • Fax: 312-259-5972

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 Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VADIM GOSHKO
Title or Position: DPM / OWNER
Credential: DPM
Phone: 773-205-0106