Provider Demographics
NPI:1902072309
Name:LOUIS J. SANFILIPPO D.P.M. S.C.
Entity Type:Organization
Organization Name:LOUIS J. SANFILIPPO D.P.M. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:SANFILIPPO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-543-3000
Mailing Address - Street 1:1250 W LAKE ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5744
Mailing Address - Country:US
Mailing Address - Phone:630-543-3000
Mailing Address - Fax:630-543-5910
Practice Address - Street 1:1250 W LAKE ST
Practice Address - Street 2:SUITE 16
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-5744
Practice Address - Country:US
Practice Address - Phone:630-543-3000
Practice Address - Fax:630-543-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0016-2814213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36935Medicare UPIN