MEDICARE: FAMILY PODIATRY CENTER LLC

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

General Provider Information

NPI Number	:	1689652570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PODIATRY CENTER LLC

Provider Business Mailing Address
First Line	:	720 BROM CT STE 201
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6534
Country	:	US
Telephone Number	:	630-355-3668
Fax Number	:	630-355-3016

Provider Business Practice Location Address
First Line	:	720 BROM CT STE 201
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6534
Country	:	US
Telephone Number	:	630-355-3668
Fax Number	:	630-355-3016

Authorized Official
Title or Position	:	OWNER
Name	:	LAWRENCE M KOSOVA
Credential	:	DPM
Telephone Number	:	630-355-3668

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	02/20/2026

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