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NPI Code Detail

MEDICARE: FOOT AND ANKLE TREATMENT CENTER OF CHICAGO, LLC

MEDICARE: FOOT AND ANKLE TREATMENT CENTER OF CHICAGO, 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
1213ES0103XFoot & Ankle Surgery Podiatrist0156005182IL

General Provider Information

NPI Number : 1740340330
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOOT AND ANKLE TREATMENT CENTER OF CHICAGO, LLC
Provider Business Mailing Address
First Line : 467 W ERIE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-5704
Country : US
Telephone Number : 312-943-7246
Fax Number : 312-944-7246
Provider Business Practice Location Address
First Line : 467 W ERIE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-5704
Country : US
Telephone Number : 312-943-7246
Fax Number : 312-944-7246
Authorized Official
Title or Position : PHYSICIAN
Name : DR. JOSHUA HEDMAN
Credential : DPM
Telephone Number : 312-943-7246
Provider Enumeration Date : 12/12/2006
Last Update Date : 07/23/2013

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