Provider Demographics
NPI:1427006568
Name:RATKOVICH, EDWARD I (DPM)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:I
Last Name:RATKOVICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10751 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1900
Mailing Address - Country:US
Mailing Address - Phone:708-460-8688
Mailing Address - Fax:708-460-9272
Practice Address - Street 1:10751 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1900
Practice Address - Country:US
Practice Address - Phone:708-460-8688
Practice Address - Fax:708-460-9272
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005180213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN189340EMedicare PIN
IN189330EMedicare PIN
ILK29707Medicare PIN