=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689690711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONWEALTH FOOT AND ANKLE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2006
-----------------------------------------------------
Last Update Date | 05/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 DUTCHMANS LN STE 104
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-4726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-459-3338
-----------------------------------------------------
Fax | 502-459-7509
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9400 S CICERO AVE STE 100
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-2536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-424-3201
-----------------------------------------------------
Fax | 708-424-5001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. STEPHEN FRASCONE
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 586-725-3444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 00157
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ER0200X
-----------------------------------------------------
Taxonomy Name | Radiology Podiatrist
-----------------------------------------------------
License Number | 00157
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 00157
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------