Healthcare Provider Details

I. General information

NPI: 1659529311
Provider Name (Legal Business Name): HEARTLAND FOOT & ANKLE ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HEARTLAND DR SUITE B
BLOOMINGTON IL
61704-7775
US

IV. Provider business mailing address

10 HEARTLAND DR SUITE B
BLOOMINGTON IL
61704-7741
US

V. Phone/Fax

Practice location:
  • Phone: 309-661-9975
  • Fax: 309-661-9920
Mailing address:
  • Phone: 309-661-9975
  • Fax: 309-661-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005357
License Number StateIL

VIII. Authorized Official

Name: DR. MELISSA JOMARIE LOCKWOOD
Title or Position: OWNER/PRESIDENT
Credential: D.P.M.
Phone: 309-661-9975