Healthcare Provider Details

I. General information

NPI: 1811180326
Provider Name (Legal Business Name): DYNAMIC FOOT &ANKLE SURGEONS,P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 CALUMET AVE SUITE 101
MUNSTER IN
46321-2545
US

IV. Provider business mailing address

10330 W ROOSEVELT RD SUITE 200
WESTCHESTER IL
60154-2571
US

V. Phone/Fax

Practice location:
  • Phone: 708-632-5612
  • Fax: 708-632-5601
Mailing address:
  • Phone: 708-632-5612
  • Fax: 708-632-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ARSHAD KHAN
Title or Position: OWNER
Credential: DPM
Phone: 773-301-3893