Provider Demographics
NPI:1992916969
Name:ATA HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:ATA HEALTH SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERELE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-978-2100
Mailing Address - Street 1:175 N HARBOR DR
Mailing Address - Street 2:SUITE 3906
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7344
Mailing Address - Country:US
Mailing Address - Phone:773-978-2100
Mailing Address - Fax:773-978-1568
Practice Address - Street 1:175 N HARBOR DR
Practice Address - Street 2:SUITE 3906
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7344
Practice Address - Country:US
Practice Address - Phone:773-978-2100
Practice Address - Fax:773-978-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001189OtherBLUE CROSS BLUE SHIELD
IL60001189OtherBLUE CROSS BLUE SHIELD
IL661800Medicare ID - Type Unspecified