Podiatry & Sports Center, LTD.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

060006511 Issued in IL

Legal business name

PODIATRY & SPORTS CENTER, LTD.

Practice address

10 N Roselle Rd
Suite 300
Roselle, IL 60172-1592

Phone

(630) 529-6634

Fax

(630) 529-6760

NPI assigned

Oct 16, 2007

Last updated

Nov 1, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David William O'Brian, DPM

Title

Owner

Phone

(630) 529-6634

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193875200000",
    "number": "1528257441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 N ROSELLE RD",
            "address_2": "SUITE 300",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601721592",
            "telephone_number": "630-529-6634",
            "fax_number": "630-529-6760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N ROSELLE RD",
            "address_2": "SUITE 300",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601721592",
            "telephone_number": "630-529-6634",
            "fax_number": "630-529-6760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PODIATRY & SPORTS CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2007-11-01",
        "status": "A",
        "authorized_official_last_name": "O'BRIAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-529-6634",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "060006511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.