Provider Demographics
NPI:1588070189
Name:FIT FEET PODIATRY SC
Entity type:Organization
Organization Name:FIT FEET PODIATRY SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOEED
Authorized Official - Middle Name:
Authorized Official - Last Name:EKBAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-952-0684
Mailing Address - Street 1:2400 N LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2747
Mailing Address - Country:US
Mailing Address - Phone:773-952-0684
Mailing Address - Fax:888-668-6550
Practice Address - Street 1:2400 N LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2747
Practice Address - Country:US
Practice Address - Phone:773-952-0684
Practice Address - Fax:888-668-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-03
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.004994213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty