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General NPI Number Information
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NPI Number | 1639507163
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Entity Type | Organization
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Legal Business Name | NORTHSIDE FOOT & ANKLE PC
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Dates
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Enumeration Date | 10/18/2013
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 750 N FRANKLIN ST SUITE 102
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City | CHICAGO
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State | IL
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Zip | 60654-6263
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Country | US
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Telephone | 312-280-7886
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Fax | 312-280-9547
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Provider Business Mailing Address
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Address Line | 750 N FRANKLIN ST STE 102
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City | CHICAGO
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State | IL
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Zip | 60654-3529
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Country | US
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Telephone | 312-280-7886
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Fax | 312-280-9547
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY S KRUSE
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Credential | DPM
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Telephone | 312-280-7886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213EP0504X
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Taxonomy Name | Public Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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