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General NPI Number Information
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NPI Number | 1700123734
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Entity Type | Organization
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Legal Business Name | CHICAGO FOOT & ORTHOPEDIC CLINIC
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 3918 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-4604
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Country | US
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Telephone | 773-376-7200
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Fax | 773-376-9211
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Provider Business Mailing Address
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Address Line | 2801 W CERMAK RD
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City | CHICAGO
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State | IL
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Zip | 60623-3513
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Country | US
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Telephone | 773-376-7200
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Fax | 773-376-9211
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | AMIN MASHOUF
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Credential |
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Telephone | 773-376-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 016004154
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License Number State | IL
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