Northside Foot & Ankle PC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

Legal business name

NORTHSIDE FOOT & ANKLE PC

Practice address

750 N Franklin St
Ste 102
Chicago, IL 60654-6263

Phone

(312) 280-7886

Fax

(312) 280-9547

NPI assigned

Dec 6, 2013

Organization subpart

No

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

Authorized official

Name

Timothy Stephen Kruse, DPM

Title

Owner/Ceo

Phone

(312) 280-7886

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1447681127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 N FRANKLIN ST",
            "address_2": "STE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606546263",
            "telephone_number": "312-280-7886",
            "fax_number": "312-280-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 N FRANKLIN ST",
            "address_2": "STE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606546263",
            "telephone_number": "312-280-7886",
            "fax_number": "312-280-9547"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1007 Church St",
            "address_2": "Ste 105",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "IL",
            "postal_code": "602013624",
            "country_code": "US",
            "telephone_number": "847-424-9888",
            "fax_number": "847-424-9649",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHSIDE FOOT & ANKLE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "KRUSE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "312-280-7886",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016005211",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "malunan@mbcservicesusa.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "malunan@mbcservicesusa.com",
            "address_1": "1007 Church St",
            "address_2": "Ste 105",
            "city": "Evanston",
            "state": "IL",
            "country_code": "US",
            "postal_code": "602013624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Foot & Ankle Surgery Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; 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.