Provider Demographics
NPI:1770881591
Name:COMPREHENSIVE FOOT AND ANKLE SPECIALISTS, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE FOOT AND ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-917-0164
Mailing Address - Street 1:PO BOX 578220
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8121
Mailing Address - Country:US
Mailing Address - Phone:847-917-0164
Mailing Address - Fax:773-935-2595
Practice Address - Street 1:150 N RIVER RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-917-0164
Practice Address - Fax:773-935-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty