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General NPI Number Information
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NPI Number | 1518969344
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Entity Type | Organization
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Legal Business Name | EVANSTON PODIATRIC SURGEONS PC
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 2500 RIDGE AVE SUITE 110
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City | EVANSTON
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State | IL
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Zip | 60201-2455
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Country | US
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Telephone | 847-475-9030
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Fax | 847-475-9031
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Provider Business Mailing Address
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Address Line | 2500 RIDGE AVE SUITE 110
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City | EVANSTON
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State | IL
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Zip | 60201-2455
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Country | US
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Telephone | 847-475-9030
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Fax | 847-475-9031
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TAYEB S HUSSAIN
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Credential | DPM
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Telephone | 847-475-9030
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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 | 016004816
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License Number State | IL
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