Provider Demographics
NPI:1124105747
Name:WEST CHICAGO FAMILY FOOT CENTER
Entity type:Organization
Organization Name:WEST CHICAGO FAMILY FOOT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-378-1000
Mailing Address - Street 1:4103 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4313
Mailing Address - Country:US
Mailing Address - Phone:773-378-1000
Mailing Address - Fax:773-521-4260
Practice Address - Street 1:4103 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4313
Practice Address - Country:US
Practice Address - Phone:773-378-1000
Practice Address - Fax:773-521-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty