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General NPI Number Information
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NPI Number | 1861115404
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Entity Type | Organization
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Legal Business Name | SUMMIT FOOT AND ANKLE CENTER P.C.
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 1515 N HARLEM AVE STE 100
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City | OAK PARK
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State | IL
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Zip | 60302-1205
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Country | US
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Telephone | 708-390-9517
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Fax |
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Provider Business Mailing Address
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Address Line | 801 S FINANCIAL PL APT 3205
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City | CHICAGO
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State | IL
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Zip | 60605-1790
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Country | US
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Telephone | 708-390-9517
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | TANVI KADAKIA
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Credential | DPM
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Telephone | 630-770-2197
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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 |
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License Number State |
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