Organization
SUBURBAN FOOT AND ANKLE SPECIALISTS P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS WASSERMAN (PRESIDENT)
(847) 219-0539
Entity
Organization
Contact information
Practice address
475 N FARNSWORTH AVE, AURORA, IL 60505-3004
(630) 898-0022
Mailing address
PO BOX 444, LAKE FOREST, IL 60045-0444
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004523326
BCBS OF ILLINOIS
IL
Enumeration date
09/17/2007
Last updated
09/17/2007
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