MEDICARE: LITSAS CENTER FOR ADVANCED FOOT CARE INC

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	016005036	IL

General Provider Information

NPI Number	:	1659506053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITSAS CENTER FOR ADVANCED FOOT CARE INC

Provider Business Mailing Address
First Line	:	4705 WILLOW SPRINGS RD
Second Line	:	S.E.SUITE
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6145
Country	:	US
Telephone Number	:	708-588-0250
Fax Number	:	708-588-0256

Provider Business Practice Location Address
First Line	:	4705 WILLOW SPRINGS RD
Second Line	:	S.E.SUITE
City	:	LA GRANGE
State	:	IL
Zip	:	60525-6145
Country	:	US
Telephone Number	:	708-588-0250
Fax Number	:	708-588-0256

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VASILIOS LITSAS
Credential	:	DPM
Telephone Number	:	708-588-0250

Provider Enumeration Date	:	05/29/2009
Last Update Date	:	12/29/2011

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