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General NPI Number Information
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NPI Number | 1023334935
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Entity Type | Organization
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Legal Business Name | ADVANCED FOOT & ANKLE SPECIALISTS SC
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Dates
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Enumeration Date | 04/16/2010
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 1750 N RANDALL RD SUITE 160
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City | ELGIN
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State | IL
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Zip | 60123-7900
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Country | US
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Telephone | 630-698-3637
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 N RANDALL RD SUITE 160
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City | ELGIN
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State | IL
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Zip | 60123-7900
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Country | US
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Telephone | 630-698-3637
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY F. OCHWAT
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Credential | DPM
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Telephone | 630-698-3637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005296
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 01600357
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License Number State | IL
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