A Bridgeport Foot and Ankle Clinic, LTD

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

A BRIDGEPORT FOOT AND ANKLE CLINIC, LTD

Practice address

9933 Lawler Ave
Suite 225
Skokie, IL 60077-3703

Phone

(312) 225-2444

Fax

(847) 674-2113

NPI assigned

Aug 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sidney Weiser, DPM

Title

President/Owner

Phone

(312) 225-2444

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1053421180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3058 W PETERSON",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60659",
            "telephone_number": "312-225-2444",
            "fax_number": "847-674-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9933 LAWLER AVE",
            "address_2": "SUITE 225",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773703",
            "telephone_number": "312-225-2444",
            "fax_number": "847-674-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "A BRIDGEPORT FOOT AND ANKLE CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WEISER",
        "authorized_official_first_name": "SIDNEY",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "312-225-2444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004192",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01635040",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.