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General NPI Number Information
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NPI Number | 1942162003
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Entity Type | Organization
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Legal Business Name | LAVOS LLC
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1718 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-7256
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Country | US
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Telephone | 312-820-6464
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Fax | 833-428-4605
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Provider Business Mailing Address
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Address Line | 1718 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-7256
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Country | US
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Telephone | 312-820-6464
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Fax | 833-428-4605
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Authorized Official
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Title or Position | OWNER
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Name | FADI ISA
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Credential | DPM
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Telephone | 312-820-6464
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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 |
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License Number State |
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