Healthcare Provider Details

I. General information

NPI: 1245970417
Provider Name (Legal Business Name): TOTAL FOOT AND ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SUPERIOR ST STE 405
MELROSE PARK IL
60160-4138
US

IV. Provider business mailing address

4149 S COTTAGE GROVE 411
CHICAGO IL
60653
US

V. Phone/Fax

Practice location:
  • Phone: 773-729-2329
  • Fax:
Mailing address:
  • Phone: 773-729-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE ATOYEBI
Title or Position: CEO
Credential:
Phone: 773-729-2329