MEDICARE: CHICAGO FOOT AND ANKLE 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D08726	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	01638903	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1760652416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO FOOT AND ANKLE PC

Provider Business Mailing Address
First Line	:	5700 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2408
Country	:	US
Telephone Number	:	773-925-5700
Fax Number	:	773-925-5775

Provider Business Practice Location Address
First Line	:	5700 S KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2408
Country	:	US
Telephone Number	:	773-925-5700
Fax Number	:	773-925-5775

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES TIMOTHY ALLEN
Credential	:	DPM
Telephone Number	:	773-925-5700

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	04/30/2015

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Directions to “CHICAGO FOOT AND ANKLE PC ” Practice Location

Language	Start Address	Practice Location

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