MEDICARE: NORTHSIDE FOOT & ANKLE PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	213ES0131X	Foot Surgery Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	213ES0103X	Foot & Ankle Surgery Podiatrist

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	:	1447681127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSIDE FOOT & ANKLE PC

Provider Business Mailing Address
First Line	:	750 N FRANKLIN ST
Second Line	:	STE 102
City	:	CHICAGO
State	:	IL
Zip	:	60654-6263
Country	:	US
Telephone Number	:	312-280-7886
Fax Number	:	312-280-9547

Provider Business Practice Location Address
First Line	:	750 N FRANKLIN ST
Second Line	:	STE 102
City	:	CHICAGO
State	:	IL
Zip	:	60654-6263
Country	:	US
Telephone Number	:	312-280-7886
Fax Number	:	312-280-9547

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	TIMOTHY STEPHEN KRUSE
Credential	:	DPM
Telephone Number	:	312-280-7886

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	05/01/2023

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