NPI 1003632126 · live from the CMS NPI Registry
Complete Innovative Care Co
Podiatrist, Foot & Ankle Surgery in Addison, IL. National Provider Identifier 1003632126, active.
NPI record
| NPI | 1003632126 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Podiatrist, Foot & Ankle Surgery 213ES0103X |
| Practice location | 274 W North Ave, Addison, IL 60101 |
| Practice phone | 708-586-8391 |
| Mailing address | 5475 Broadway # 311, Merrillville, IN 46410 |
| Enumerated | November 25, 2024 |
| Last updated | November 25, 2024 |
| Authorized official | Mohammad Usman, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Podiatrist | 213E00000X | — |
| Podiatrist, Foot & Ankle Surgery primary | 213ES0103X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.