MEDICARE: FOOT FIRST PODIATRY CENTERS, V.P.C.

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		IL

General Provider Information

NPI Number	:	1528276169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT FIRST PODIATRY CENTERS, V.P.C.

Provider Business Mailing Address
First Line	:	1601 W WISE RD
Second Line	:
City	:	SCHAUMBURG
State	:	IL
Zip	:	60193-3554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 7TH ST
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-6870
Country	:	US
Telephone Number	:	309-762-9242
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEITH SKLAR
Credential	:
Telephone Number	:	309-762-9242

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	01/16/2008

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