Tae-Jun Ahn, D.P.M.
Individual provider Active NPI Foot & Ankle Surgery Podiatrist · Glenview, IL
NPI 1003923764 · NPPES record last updated Nov 11, 2024
Key facts
- NPI
- 1003923764
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- 016005105 (IL)
- Practice address
- 1640 Pleasant LN
Glenview, IL 60025-1847 - Phone
- (773) 989-2500
- Fax
- (877) 834-6714
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 10, 2020 through Feb 10, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016005105 | IL | MD | Foot & Ankle Surgery Podiatrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | 016005105 | IL | Yes |
Addresses
Primary practice location
1640 Pleasant LN
Glenview, IL 60025-1847
Mailing address
1640 Pleasant LN
Glenview, IL 60025-1847
Phone (773) 989-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016005105 | Medicaid | IL | |
| P00631105 | Other | IL | MEDICARE RAILROAD |
Other providers in Glenview, IL
- Colette Marie Ahlberg
- Rauqelle Ahlfeld
- Deepali Ahluwalia
- Maryam Ahmad
- May Ahn
- Arya Aiwin
- Seray Akcesme
- Joseph Akhikar
- Yumna Alam
- Kimberly G Albarran
All providers in Glenview, IL · Foot & Ankle Surgery Podiatrist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.