Healthcare Provider Details

I. General information

NPI: 1104083369
Provider Name (Legal Business Name): MODERN FOOT & ANKLE CENTERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S DOBSON RD STE E40
CHANDLER AZ
85224-5693
US

IV. Provider business mailing address

2680 S VAL VISTA DR STE 177
GILBERT AZ
85295-1674
US

V. Phone/Fax

Practice location:
  • Phone: 480-909-3700
  • Fax: 877-839-9972
Mailing address:
  • Phone: 480-909-3700
  • Fax: 877-839-9972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ILONA EVZEN SIGLOVA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 480-909-3700