Organization
LOGAN SQUARE FOOT CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARRY S. ISENSTADT D.P.M. (DOCTOR)
(773) 772-4440
Entity
Organization
Contact information
Practice address
2831 N MILWAUKEE AVE, CHICAGO, IL 60618-7403
(773) 772-4440
(773) 772-4461
Mailing address
2831 N MILWAUKEE AVE, CHICAGO, IL 60618-7403
(773) 772-4440
(773) 772-4461
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
016002700
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060020807
BCBS
IL
05
—
016002700
—
IL
01
—
1952358574
NPI
IL
Enumeration date
02/25/2008
Last updated
09/06/2013
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