Healthcare Provider Details

I. General information

NPI: 1679487946
Provider Name (Legal Business Name): ELMHURST FOOT & ANKLE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E ARMY TRAIL RD STE 101
BLOOMINGDALE IL
60108-2140
US

IV. Provider business mailing address

303 E ARMY TRAIL RD STE 101
BLOOMINGDALE IL
60108-2140
US

V. Phone/Fax

Practice location:
  • Phone: 630-893-3668
  • Fax:
Mailing address:
  • Phone: 630-893-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEEP N SHAH
Title or Position: CO-OWNER
Credential: DPM
Phone: 518-330-7689