Michigan Ave Podiatry LLC 1

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

016004918 Issued in IL

Legal business name

MICHIGAN AVE PODIATRY LLC 1

Practice address

30 N Michigan Ave
Suite 720
Chicago, IL 60602-3809

Phone

(312) 701-0770

Fax

(312) 701-0705

NPI assigned

Aug 8, 2013

Last updated

Aug 26, 2015By 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. Pam A Eernisse, DPM

Title

Stockholder

Phone

(312) 701-0770

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Pamela A Eernisse, DPM

  • Podiatrist
  • Justice, IL
  • NPI 1427036151
  Medicare reassignment NPD
• Anna M Garbula, DPM

  • Foot & Ankle Surgery Podiatrist
  • Lombard, IL
  • NPI 1720341035
  Medicare reassignment NPD
• Amer Hosain, DPM

  • Foot & Ankle Surgery Podiatrist
  • Chicago, IL
  • NPI 1538789490
  Medicare reassignment NPD
• Zane Irfan Qureshi, DPM

  • Podiatrist
  • Chicago, IL
  • NPI 1376036806
  Medicare reassignment NPD
• Christopher Anthony Daniele, DPM

  • Foot & Ankle Surgery Podiatrist
  • Flossmoor, IL
  • NPI 1962507772
  NPD (past)
• Zohaib Hassan

  • Foot & Ankle Surgery Podiatrist
  • Chicago, IL
  • NPI 1891377479
  NPD (past)
• Kelsey L Krotiak, DPM

  • Podiatrist
  • Rockford, IL
  • NPI 1568085710
  NPD (past)
• Kevin James Oconnor, D.P.M.

  • Foot Surgery Podiatrist
  • Flossmoor, IL
  • NPI 1871521286
  NPD (past)
• Yousha Bin Khalid Siddiqui, DPM

  • Foot & Ankle Surgery Podiatrist
  • Decatur, IL
  • NPI 1942871074
  NPD (past)
• Tracy Ellington, DPM

  • Foot Surgery Podiatrist
  • Jonesboro, AR
  • NPI 1770592636
  NPD (past)

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

{
    "created_epoch": "1375920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1881026185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE",
            "address_2": "SUITE 720",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023809",
            "telephone_number": "312-701-0770",
            "fax_number": "312-701-0705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 N MICHIGAN AVE",
            "address_2": "SUITE 720",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606023809",
            "telephone_number": "312-701-0770",
            "fax_number": "312-701-0705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN AVE PODIATRY LLC 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-08",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "EERNISSE",
        "authorized_official_first_name": "PAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "STOCKHOLDER",
        "authorized_official_telephone_number": "312-701-0770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016004918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Michelsen
• Kelly Nicole Michelson, MD MPH
• Kenneth Alan Michelson, M.D.
• Michigan Ave Chiropractic and Wellness
• Michigan Ave Medical Associates LLC
• Michigan Ave Psychiatry & Counseling Center
• Michigan Avenue Center for Health, LTD.
• Michigan Avenue ENT P.C.
• Michigan Avenue Hearing Health P.C.
• Michigan Avenue Immediate Care

• 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 Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.