MEDICARE: JAMES G ELIPAS DPM 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	213ES0103X	Foot & Ankle Surgery Podiatrist	016003109	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60001157	OTHER	IL	BC/BS OF ILLINOIS

General Provider Information

NPI Number	:	1649307711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES G ELIPAS DPM PC

Provider Business Mailing Address
First Line	:	6304 N NAGLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3614
Country	:	US
Telephone Number	:	773-853-0081
Fax Number	:	773-853-2970

Provider Business Practice Location Address
First Line	:	6304 N NAGLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60646-3614
Country	:	US
Telephone Number	:	773-853-0081
Fax Number	:	773-853-2970

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	DR. JAMES G ELIPAS
Credential	:	DPM
Telephone Number	:	773-853-0081

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	06/04/2013

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