MEDICARE: ADVANCED FOOT CARE CENTER

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621292	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1477632743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED FOOT CARE CENTER

Provider Business Mailing Address
First Line	:	PO BOX 578246
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-8246
Country	:	US
Telephone Number	:	773-472-1882
Fax Number	:	773-472-1891

Provider Business Practice Location Address
First Line	:	2834 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4202
Country	:	US
Telephone Number	:	773-472-1882
Fax Number	:	773-472-1891

Authorized Official
Title or Position	:	PODIATRIST
Name	:	MRS. HAZEL HERNANDEZ
Credential	:	DPM
Telephone Number	:	773-472-1882

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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Directions to “ADVANCED FOOT CARE CENTER ” Practice Location

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