Healthcare Provider Details

I. General information

NPI: 1578837514
Provider Name (Legal Business Name): LAPLANT FOOT & ANKLE CLINIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 E NEW YORK ST
AURORA IL
60504-4465
US

IV. Provider business mailing address

3535 E NEW YORK ST
AURORA IL
60504-4465
US

V. Phone/Fax

Practice location:
  • Phone: 630-800-1374
  • Fax: 630-800-1638
Mailing address:
  • Phone: 630-800-1374
  • Fax: 630-800-1638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005423
License Number StateIL

VIII. Authorized Official

Name: TINA BOMBARD
Title or Position: BILLING MANAGER
Credential:
Phone: 630-897-6851