=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487728002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELMHURST PODIATRY CENTER LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2006
-----------------------------------------------------
Last Update Date | 09/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 277 N YORK ST
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-279-6565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 277 N YORK ST
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-2726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-279-6565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. JARED P FRANKEL
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 630-279-6565
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 060008415
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------