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Organization

FOOTCO ORTHOPEDIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TIM PORCELLI LC PED (DIRECTOR, CHIEF CLINICIAN)
(312) 409-2175
Entity
Organization

Contact information

Practice address
3723 N SOUTHPORT AVE, CHICAGO, IL 60613-3718
(312) 409-2175
Mailing address
PO BOX 13377, CHICAGO, IL 60613-0377

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
212.000115
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1670909
BLUE CROSS
IL
Enumeration date
05/28/2008
Last updated
05/28/2008
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