MEDICARE: GREAT LAKES FOOT & ANKLE INSTITUTE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	2086S0102X	Surgical Critical Care Physician
3	208D00000X	General Practice Physician
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
5	213E00000X	Podiatrist
6	363LF0000X	Family Nurse Practitioner
7	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1063445237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT LAKES FOOT & ANKLE INSTITUTE PLLC

Provider Business Mailing Address
First Line	:	9400 S CICERO AVE STE 100
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2536
Country	:	US
Telephone Number	:	708-424-3201
Fax Number	:	708-424-5001

Provider Business Practice Location Address
First Line	:	32743 23 MILE RD STE 110
Second Line	:
City	:	CHESTERFIELD
State	:	MI
Zip	:	48047-2082
Country	:	US
Telephone Number	:	586-725-3444
Fax Number	:	586-725-0984

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHEN FRASCONE
Credential	:	DPM
Telephone Number	:	586-725-3444

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	05/17/2025

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