Organization
PODIATRIC MANAGEMENT SYSTEMS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PATRICE COOPER (ADMINISTRATOR)
(312) 372-1160
Entity
Organization
Contact information
Practice address
765 ELA RD, LAKE ZURICH, IL 60047-2385
(847) 540-9949
(847) 540-9971
Mailing address
70 E LAKE ST STE 1102, CHICAGO, IL 60601-7499
(312) 372-1160
(312) 372-3346
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1621423
BCBS PROVIDER NUMBER
IL
01
—
90001026
BCBS PROVIDER NUMBER
IN
Enumeration date
04/11/2007
Last updated
09/02/2020
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