MEDICARE: SOUTH SHORE FOOT AND ANKLE WELLNESS 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	261QP1100X	Podiatric Clinic/Center

General Provider Information

NPI Number	:	1831886209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SHORE FOOT AND ANKLE WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	2223 E 79TH STREET, CHICAGO , IL. 60649
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649
Country	:	US
Telephone Number	:	773-978-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 E 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-5016
Country	:	US
Telephone Number	:	773-978-2100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER AKERELE
Credential	:	DPM
Telephone Number	:	773-978-2100

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	08/11/2023

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