Provider Demographics
NPI:1023419538
Name:OPENSKY PODIATRY INC.
Entity type:Organization
Organization Name:OPENSKY PODIATRY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:OPENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-747-8994
Mailing Address - Street 1:6225 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2818
Mailing Address - Country:US
Mailing Address - Phone:708-747-8994
Mailing Address - Fax:847-965-6325
Practice Address - Street 1:6225 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2818
Practice Address - Country:US
Practice Address - Phone:708-747-8994
Practice Address - Fax:847-965-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005221213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty