Provider Demographics
NPI:1164678132
Name:OAK LAWN FOOT & ANKLE CENTER, P.C.
Entity type:Organization
Organization Name:OAK LAWN FOOT & ANKLE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EMANUEL
Authorized Official - Last Name:FINKELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-636-7677
Mailing Address - Street 1:4603 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4718
Mailing Address - Country:US
Mailing Address - Phone:708-636-7677
Mailing Address - Fax:708-636-3137
Practice Address - Street 1:4603 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4718
Practice Address - Country:US
Practice Address - Phone:708-636-7677
Practice Address - Fax:708-636-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004567213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480011748OtherRAILROAD MEDICARE
IL016004567Medicaid
IL016004567Medicaid