MEDICARE: PERNS 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	016002468	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801949565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERNS FOOT AND ANKLE, PC

Provider Business Mailing Address
First Line	:	3115 N HARLEM AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60634-4684
Country	:	US
Telephone Number	:	773-836-9900
Fax Number	:	773-836-9935

Provider Business Practice Location Address
First Line	:	3115 N HARLEM AVE
Second Line	:	SUITE 200
City	:	CHICAGO
State	:	IL
Zip	:	60634-4684
Country	:	US
Telephone Number	:	773-836-9900
Fax Number	:	773-836-9935

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VINCENT A. PERNS
Credential	:	DPM
Telephone Number	:	773-836-9900

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	10/29/2007

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