| Organization Name: | SUBURBAN PODIATRY ASSOCIATES, P.C. |
| NPI Number: | 1073817805 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY MARTIN JANSYN (PRESIDENT) |
| Mailing Address: | 303 E Army Trail Rd Suite #101 Bloomingdale |
| State: | IL US |
| Postal Code: | 601082169 |
| Phone Number: | 6308933668 |
| Fax Number: | 6308933670 |
| NPI Enumeration Date: | 01/09/2011 |
| NPI Last Update Date: | 02/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 016-003968 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |