Provider Demographics
NPI:1528270766
Name:UNITED FOOT & ANKLE SURGEONS, P.C.
Entity type:Organization
Organization Name:UNITED FOOT & ANKLE SURGEONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAE-JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-989-2500
Mailing Address - Street 1:1640 PLEASANT LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-1847
Mailing Address - Country:US
Mailing Address - Phone:773-989-2500
Mailing Address - Fax:773-989-0011
Practice Address - Street 1:1640 PLEASANT LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1847
Practice Address - Country:US
Practice Address - Phone:773-989-2500
Practice Address - Fax:877-834-6714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005105213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005105Medicaid
ILDN6541OtherMEDICARE RAILROAD
IL016005105Medicaid
IL205236Medicare PIN