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General NPI Number Information
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NPI Number | 1093944522
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Entity Type | Organization
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Legal Business Name | FOOT & ANKLE PHYSICIANS GROUP, PC
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Dates
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Enumeration Date | 07/06/2009
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 5012 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3822
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Country | US
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Telephone | 773-282-3377
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Fax | 773-205-4439
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Provider Business Mailing Address
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Address Line | 5012 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3822
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Country | US
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Telephone | 773-282-3377
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Fax | 773-205-4439
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. LISA COHEN
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Credential | D.P.M.
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Telephone | 773-282-3377
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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 | 016005305
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License Number State | IL
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