MEDICARE: EVANSTON PODIATRIC SURGEONS 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	016004816	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	:	1518969344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANSTON PODIATRIC SURGEONS PC

Provider Business Mailing Address
First Line	:	2500 RIDGE AVE
Second Line	:	SUITE 110
City	:	EVANSTON
State	:	IL
Zip	:	60201-2455
Country	:	US
Telephone Number	:	847-475-9030
Fax Number	:	847-475-9031

Provider Business Practice Location Address
First Line	:	2500 RIDGE AVE
Second Line	:	SUITE 110
City	:	EVANSTON
State	:	IL
Zip	:	60201-2455
Country	:	US
Telephone Number	:	847-475-9030
Fax Number	:	847-475-9031

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TAYEB S HUSSAIN
Credential	:	DPM
Telephone Number	:	847-475-9030

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/22/2010

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