Healthcare Provider Details
I. General information
NPI: 1942474036
Provider Name (Legal Business Name): FOREST VIEW PODIATRY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 04/18/2008
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1760 W ALGONQUIN RD
HOFFMAN ESTATES IL
60192-1573
US
IV. Provider business mailing address
1760 W ALGONQUIN RD
HOFFMAN ESTATES IL
60192-1573
US
V. Phone/Fax
- Phone: 847-991-3111
- Fax:
- Phone: 847-991-3111
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 213ES0000X |
| Taxonomy | Sports Medicine Podiatrist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 213ES0103X |
| Taxonomy | Foot & Ankle Surgery Podiatrist |
| License Number | 16-002796 |
| License Number State | IL |
VIII. Authorized Official
Name: DR.
WILLIAM
ALBERT
MOHS
Title or Position: PODIATRIST
Credential: DPM FACFAS
Phone: 847-991-3111