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General NPI Number Information
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NPI Number | 1689736985
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Entity Type | Organization
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Legal Business Name | FOOT CARE CONSULTANTS
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 5511 1/2 W MONTROSE
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City | CHICAGO
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State | IL
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Zip | 60641-1331
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Country | US
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Telephone | 773-283-6200
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Fax | 773-283-7578
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Provider Business Mailing Address
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Address Line | 5511 1/2 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60641-1331
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Country | US
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Telephone | 773-283-6200
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Fax | 773-283-7578
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Authorized Official
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Title or Position | PARTNER
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Name | DR. LAWRENCE MARIZAK
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Credential | DPM
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Telephone | 773-283-6200
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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 | 016003003
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0160033252
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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