Provider Demographics
NPI:1528434396
Name:PRECISION FOOT SURGEONS, LLC
Entity type:Organization
Organization Name:PRECISION FOOT SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAE-JUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-689-8150
Mailing Address - Street 1:7319 W. NORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1220
Mailing Address - Country:US
Mailing Address - Phone:708-689-8150
Mailing Address - Fax:708-689-8465
Practice Address - Street 1:7319 W. NORTH AVENUE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1220
Practice Address - Country:US
Practice Address - Phone:708-689-8150
Practice Address - Fax:708-689-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty