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General NPI Number Information
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NPI Number | 1427235969
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Entity Type | Organization
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Legal Business Name | CHICAGOLAND FOOT SURGERY CENTER
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 1121 W GREENWOOD AVE
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City | WAUKEGAN
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State | IL
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Zip | 60087-4919
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Country | US
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Telephone | 847-336-3338
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Fax | 847-336-0683
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Provider Business Mailing Address
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Address Line | 1121 W GREENWOOD AVE
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City | WAUKEGAN
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State | IL
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Zip | 60087-4919
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Country | US
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Telephone | 847-336-3338
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Fax | 847-336-0683
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ADDY VELA
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Credential |
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Telephone | 847-336-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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