Healthcare Provider Details

I. General information

NPI: 1144416603
Provider Name (Legal Business Name): AURORA FOOT CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 N LAKE ST
AURORA IL
60506-4186
US

IV. Provider business mailing address

356 N LAKE ST
AURORA IL
60506-4186
US

V. Phone/Fax

Practice location:
  • Phone: 630-896-5005
  • Fax: 630-896-5087
Mailing address:
  • Phone: 630-896-5005
  • Fax: 630-896-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016002865
License Number StateIL

VIII. Authorized Official

Name: DR. MARSHALL G BALDING
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 630-896-5005