Healthcare Provider Details

I. General information

NPI: 1174523963
Provider Name (Legal Business Name): FOOT CARE CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 CHASE ST STE 1A
ALGONQUIN IL
60102-9668
US

IV. Provider business mailing address

PO BOX 5670
VILLA PARK IL
60181-5670
US

V. Phone/Fax

Practice location:
  • Phone: 847-705-6765
  • Fax: 630-359-4600
Mailing address:
  • Phone: 847-705-6765
  • Fax: 630-359-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CARRIE N NELSON
Title or Position: OWNER
Credential: DPM
Phone: 847-705-6765