Healthcare Provider Details

I. General information

NPI: 1295723435
Provider Name (Legal Business Name): ASSOCIATED FOOT AND ANKLE CLINICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BRIARCLIFF PROF CTR
BOURBONNAIS IL
60914-1775
US

IV. Provider business mailing address

301 E HICKORY ST SUITE 2
STREATOR IL
61364-2287
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-7077
  • Fax: 815-933-4430
Mailing address:
  • Phone: 815-672-0280
  • Fax: 815-672-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number060007405
License Number StateIL

VIII. Authorized Official

Name: DR. DANIEL N BENOIT
Title or Position: PRESIDENT
Credential: DPM
Phone: 815-933-7077