Organization
ACTIVE FOOT & ANKLE ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY W MINEROF DPM (OWNER)
(773) 762-2000
Entity
Organization
Contact information
Practice address
3935 W 26TH ST, CHICAGO, IL 60623-3706
(773) 762-2000
(773) 762-3350
Mailing address
3935 W 26TH ST, CHICAGO, IL 60623-3706
(773) 762-2000
(773) 762-3350
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60010797
BCBS
IL
Enumeration date
03/20/2007
Last updated
03/23/2011
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