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General NPI Number Information
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NPI Number | 1174629265
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Entity Type | Organization
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Legal Business Name | NORTH SUBURBAN FOOT & ANKLE CENTERS
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 400 LAKE COOK RD SUITE 101
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City | DEERFIELD
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State | IL
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Zip | 60015-5607
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Country | US
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Telephone | 847-940-9880
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Fax | 847-940-9890
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Provider Business Mailing Address
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Address Line | 400 LAKE COOK RD SUITE 101
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City | DEERFIELD
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State | IL
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Zip | 60015-5607
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Country | US
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Telephone | 847-940-9880
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Fax | 847-940-9890
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. MICHAEL IRA WEISMAN
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Credential | D.P.M.
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Telephone | 847-940-9880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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