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General NPI Number Information
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NPI Number | 1477679397
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Entity Type | Organization
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Legal Business Name | LAKE ZURICH PODIATRY PC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/20/2014
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Provider Practice Location Address
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Address Line | 950 W MAIN ST SUITE 105
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City | LAKE ZURICH
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State | IL
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Zip | 60047-3417
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Country | US
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Telephone | 847-540-0234
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Fax | 847-540-0867
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Provider Business Mailing Address
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Address Line | 950 W MAIN ST SUITE 105
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City | LAKE ZURICH
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State | IL
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Zip | 60047-3417
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Country | US
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Telephone | 847-540-0234
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Fax | 847-540-0867
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELIZABETH JEAN SOSINSKI
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Credential | D.P.M.
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Telephone | 847-540-0234
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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 | 016-003263
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License Number State | IL
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