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General NPI Number Information
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NPI Number | 1760721963
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Entity Type | Organization
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Legal Business Name | ILLINOIS FOOT AND ANKLE SPECIALISTS, P.C.
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 5485 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1249
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Country | US
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Telephone | 773-763-6655
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Fax | 773-763-5117
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Provider Business Mailing Address
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Address Line | 557 N PLAMONDON DR
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City | ADDISON
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State | IL
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Zip | 60101-1933
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Country | US
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Telephone | 630-699-5089
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Fax | 914-459-0062
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Authorized Official
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Title or Position | OWNER
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Name | KATARZYNA NIETUPSKI
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Credential | D.P.M.
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Telephone | 630-699-5089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016005453
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License Number State | IL
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