Provider Demographics
NPI:1861115404
Name:SUMMIT FOOT AND ANKLE CENTER P.C.
Entity type:Organization
Organization Name:SUMMIT FOOT AND ANKLE CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TANVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-770-2197
Mailing Address - Street 1:801 S FINANCIAL PL APT 3205
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1790
Mailing Address - Country:US
Mailing Address - Phone:708-390-9517
Mailing Address - Fax:
Practice Address - Street 1:1515 N HARLEM AVE STE 100
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1205
Practice Address - Country:US
Practice Address - Phone:708-390-9517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty