1134663172 NPI number — INSTITUTE OF FOOT & ANKLE RECONSTRUCTIVE SURGERY OF ILLINOIS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134663172 NPI number — INSTITUTE OF FOOT & ANKLE RECONSTRUCTIVE SURGERY OF ILLINOIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUTE OF FOOT & ANKLE RECONSTRUCTIVE SURGERY OF ILLINOIS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1134663172
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9120 DOUBLETREE DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWN POINT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46307-7655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-736-1010
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9933 S WESTERN AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60643-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-445-8700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
EL SAMAD
Authorized Official First Name:
AHMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-445-8700

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  07001024 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com