MEDICARE: SUBURBAN PODIATRY GROUP, PC

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	213E00000X	Podiatrist	016003004	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316089881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBURBAN PODIATRY GROUP, PC

Provider Business Mailing Address
First Line	:	7008 N CALIFORNIA AVE
Second Line	:	STORE FRONT
City	:	CHICAGO
State	:	IL
Zip	:	60645-3029
Country	:	US
Telephone Number	:	773-274-3338
Fax Number	:	773-338-8757

Provider Business Practice Location Address
First Line	:	7008 N CALIFORNIA AVE
Second Line	:	STORE FRONT
City	:	CHICAGO
State	:	IL
Zip	:	60645-3029
Country	:	US
Telephone Number	:	773-274-3338
Fax Number	:	773-338-8757

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FRED E HUSS
Credential	:	D.P.M.
Telephone Number	:	773-274-3338

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	02/14/2013

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