Healthcare Provider Details

I. General information

NPI: 1912019548
Provider Name (Legal Business Name): ITASCA FOOT AND ANKLE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N WALNUT ST
ITASCA IL
60143-1730
US

IV. Provider business mailing address

209 N WALNUT ST
ITASCA IL
60143-1769
US

V. Phone/Fax

Practice location:
  • Phone: 630-773-2478
  • Fax: 630-773-3695
Mailing address:
  • Phone: 630-773-2478
  • Fax: 630-773-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016 004114
License Number StateIL

VIII. Authorized Official

Name: MARIE CATHERINE SCHLUND
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 630-773-2478