Organization
EDGEWATER BEACH FOOT AND ANKLE CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BENITA J KAPNICK (OFFICE MANAGER)
(773) 271-0807
Entity
Organization
Contact information
Practice address
5331 N SHERIDAN RD, CHICAGO, IL 60640-2531
(773) 271-0807
(484) 723-7350
Mailing address
800 AUSTIN ST STE 508, EVANSTON, IL 60202-3445
(773) 271-0807
(484) 723-7350
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
016002871
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016002871
—
IL
01
—
480021114
MEDICARE PALMETTO
IL
01
—
60000959
BLUE CROSS BLUE SHIELD
IL
Enumeration date
04/20/2007
Last updated
07/27/2020
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