# MICHIGAN AVE PODIATRY LLC 1

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881026185
- **Authorized official:** DR. PAM A EERNISSE DPM (STOCKHOLDER)
- **Authorized official phone:** (312) 701-0770

## Contact information

- **Practice address:** 30 N MICHIGAN AVE, SUITE 720, CHICAGO, IL 60602-3809
- **Practice address phone:** (312) 701-0770
- **Practice address fax:** (312) 701-0705
- **Mailing address:** 30 N MICHIGAN AVE, SUITE 720, CHICAGO, IL 60602-3809
- **Mailing address phone:** (312) 701-0770
- **Mailing address fax:** (312) 701-0705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016004918 | IL | Yes |

## Other

- **Enumeration date:** 08/08/2013
- **Last updated:** 08/26/2015