1649322207 NPI number — MIDWEST FOOT AND ANKLE CENTER, PC

Table of content: (NPI 1649322207)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649322207 NPI number — MIDWEST FOOT AND ANKLE CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST FOOT AND ANKLE CENTER, PC
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:
1649322207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8310 LEMONT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DARIEN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60561-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-218-0014
Provider Business Mailing Address Fax Number:
630-515-0014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8310 LEMONT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60561-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-218-0014
Provider Business Practice Location Address Fax Number:
630-515-0014
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SONGCO-CHI
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-218-0014

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  016-005222 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 016-005030 , 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: 016-005030 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1558337303 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1699744060 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 016005030 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016005222 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016-005222 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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