1821182361 NPI number — S KHALID HUSAIN DPM

Table of content: LUISA MARRERO SANTIAGO M.D. (NPI 1770712549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821182361 NPI number — S KHALID HUSAIN DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUSAIN
Provider First Name:
S
Provider Middle Name:
KHALID
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821182361
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
880 WEST CENTRAL RD - SUITE 3500
Provider Second Line Business Mailing Address:
MIDWEST FOOT & ANKLE CLINICS
Provider Business Mailing Address City Name:
ARLINGTON HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-398-8637
Provider Business Mailing Address Fax Number:
847-398-4349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 WEST CENTRAL RD - SUITE 3500
Provider Second Line Business Practice Location Address:
MIDWEST FOOT & ANKLE CLINICS
Provider Business Practice Location Address City Name:
ARLINGTON HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-398-8637
Provider Business Practice Location Address Fax Number:
847-398-4349
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  016004842 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 016004842 . This is a "IL STATE LICENSE #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 016004842 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".