Organization
ILLINOIS FOOT AND ANKLE SPECIALISTS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATARZYNA NIETUPSKI D.P.M. (OWNER)
(630) 699-5089
Entity
Organization
Contact information
Practice address
5485 N MILWAUKEE AVE, CHICAGO, IL 60630-1249
(773) 763-6655
(773) 763-5117
Mailing address
557 N PLAMONDON DR, ADDISON, IL 60101-1933
(630) 699-5089
(914) 459-0062
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005453
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
347886727-60630-30
—
IL
01
—
520330001
MEDICARE PROVIDER TRANSACTION ACCESS NUMBER
IL
Enumeration date
02/07/2013
Last updated
02/07/2013
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