Provider Demographics
NPI:1144552597
Name:KANE PODIATRY ASSOCIATES, S.C.
Entity type:Organization
Organization Name:KANE PODIATRY ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MYTYCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-232-9000
Mailing Address - Street 1:2172 BLACKBERRY DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1102
Mailing Address - Country:US
Mailing Address - Phone:630-232-9000
Mailing Address - Fax:630-232-9025
Practice Address - Street 1:2172 BLACKBERRY DR
Practice Address - Street 2:SUITE 112
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-1102
Practice Address - Country:US
Practice Address - Phone:630-232-9000
Practice Address - Fax:630-232-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005082213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU93517Medicare UPIN
6390200001Medicare NSC