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NPI Code Detail

MEDICARE: SOUTH CHICAGO FOOT & ANKLE CENTER, LTD

MEDICARE: SOUTH CHICAGO FOOT & ANKLE CENTER, LTD
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
1261QP1100XPodiatric Clinic/Center

General Provider Information

NPI Number : 1962574103
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH CHICAGO FOOT & ANKLE CENTER, LTD
Provider Business Mailing Address
First Line : 1706 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2740
Country : US
Telephone Number : 773-374-5300
Fax Number : 773-374-5860
Provider Business Practice Location Address
First Line : 1706 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-2740
Country : US
Telephone Number : 773-374-5300
Fax Number : 773-374-5860
Authorized Official
Title or Position : PRESIDENT
Name : JONDELLE JENKINS
Credential : DPM
Telephone Number : 773-374-5300
Provider Enumeration Date : 11/14/2006
Last Update Date : 09/25/2007

Similar Medicare Providers

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1706 E 87TH ST
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1720322480 — MS. VELINDA DENISE ALEXANDER
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1003363540 — DARLA THOMAS
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Directions to “SOUTH CHICAGO FOOT & ANKLE CENTER, LTD ” Practice Location

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