Provider Demographics
NPI:1649322207
Name:MIDWEST FOOT AND ANKLE CENTER, PC
Entity type:Organization
Organization Name:MIDWEST FOOT AND ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:SONGCO-CHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-218-0014
Mailing Address - Street 1:8310 LEMONT RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-1510
Mailing Address - Country:US
Mailing Address - Phone:630-218-0014
Mailing Address - Fax:630-515-0014
Practice Address - Street 1:8310 LEMONT RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-1510
Practice Address - Country:US
Practice Address - Phone:630-218-0014
Practice Address - Fax:630-515-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005222213ES0103X
IL016-005030213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-005030Medicaid
1558337303OtherNPI
1699744060OtherNPI
IL016005030Medicaid
IL016005222Medicaid
IL016-005222Medicaid
1558337303OtherNPI
IL016-005030Medicaid
IL016005030Medicaid
IL016005222Medicaid
IL6212650002Medicare NSC
ILK36066Medicare PIN
IL211784Medicare PIN