Healthcare Provider Details

I. General information

NPI: 1639270663
Provider Name (Legal Business Name): ELGIN FOOT & ANKLE CENTER, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 FLETCHER DR STE 300
ELGIN IL
60123
US

IV. Provider business mailing address

750 FLETCHER DR STE 300
ELGIN IL
60123-4703
US

V. Phone/Fax

Practice location:
  • Phone: 847-741-3127
  • Fax: 847-741-3173
Mailing address:
  • Phone: 847-741-3127
  • Fax: 847-741-3173

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: DR. KENNETH E JACOBY
Title or Position: PRESIDENT
Credential: DPM
Phone: 847-741-3127