MEDICARE: DR. VASILIOS LITSAS DPM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	016005036	IL

General Provider Information

NPI Number	:	1114958543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VASILIOS LITSAS DPM

Provider Business Mailing Address
First Line	:	4705 WILLOW SPRINGS RD
Second Line	:	S.E. SUITE
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6145
Country	:	US
Telephone Number	:	708-588-0250
Fax Number	:	708-588-0256

Provider Business Practice Location Address
First Line	:	4705 WILLOW SPRINGS RD
Second Line	:	S.E. SUITE
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6145
Country	:	US
Telephone Number	:	708-588-0250
Fax Number	:	708-588-0256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/31/2009

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