Healthcare Provider Details

I. General information

NPI: 1285267328
Provider Name (Legal Business Name): NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 GRANDSTAND PL
ELGIN IL
60123-4980
US

IV. Provider business mailing address

750 E TERRA COTTA AVE STE C
CRYSTAL LAKE IL
60014-3621
US

V. Phone/Fax

Practice location:
  • Phone: 847-639-5800
  • Fax:
Mailing address:
  • Phone: 847-639-5800
  • Fax: 815-526-3467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PATRICK ALLEN MCENEANEY
Title or Position: OWNER
Credential: DPM
Phone: 847-639-5800