MEDICARE: CHICAGO FOOT & ANKLE CLINIC

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	016004154	IL

General Provider Information

NPI Number	:	1891040424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO FOOT & ANKLE CLINIC

Provider Business Mailing Address
First Line	:	2801 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3513
Country	:	US
Telephone Number	:	773-376-7200
Fax Number	:	773-376-9211

Provider Business Practice Location Address
First Line	:	2801 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-3513
Country	:	US
Telephone Number	:	773-376-7200
Fax Number	:	773-376-9211

Authorized Official
Title or Position	:	CEO
Name	:	SHAWNI MOSHI
Credential	:
Telephone Number	:	773-376-7200

Provider Enumeration Date	:	07/19/2012
Last Update Date	:	07/19/2012

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