Provider Demographics
NPI:1316143530
Name:ADVANCED FOOT CARE OF PALATINE, P.C.
Entity type:Organization
Organization Name:ADVANCED FOOT CARE OF PALATINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SURAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-358-7005
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60078-0965
Mailing Address - Country:US
Mailing Address - Phone:847-358-7005
Mailing Address - Fax:847-358-7065
Practice Address - Street 1:711 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-0715
Practice Address - Country:US
Practice Address - Phone:847-358-7005
Practice Address - Fax:847-358-7065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001608OtherBLUE CROSS BLUE SHIELD IL
IL765650Medicare PIN
IL60001608OtherBLUE CROSS BLUE SHIELD IL
IL0854660001Medicare NSC