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General NPI Number Information
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NPI Number | 1457674566
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Entity Type | Organization
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Legal Business Name | ACCREDITED FOOT SURGEONS LTD
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Dates
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Enumeration Date | 03/03/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 17728 OAK PARK AVE STE A
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City | TINLEY PARK
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State | IL
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Zip | 60477-2063
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Country | US
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Telephone | 708-429-5252
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Fax | 708-429-5981
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Provider Business Mailing Address
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Address Line | 17728 OAK PARK AVE STE A
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City | TINLEY PARK
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State | IL
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Zip | 60477-2063
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Country | US
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Telephone | 708-429-5252
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Fax | 708-429-5981
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Authorized Official
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Title or Position | PRESIDENT-PROVIDER
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Name | DR. GARY J THOMAS
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Credential | D.P.M.
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Telephone | 708-429-5252
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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 | 016-003064
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License Number State | IL
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