Healthcare Provider Details

I. General information

NPI: 1508049826
Provider Name (Legal Business Name): MOKENA FOOT &ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19841 WOLF RD
MOKENA IL
60448-1315
US

IV. Provider business mailing address

19841 WOLF RD
MOKENA IL
60448-1315
US

V. Phone/Fax

Practice location:
  • Phone: 708-479-0790
  • Fax: 708-479-0792
Mailing address:
  • Phone: 708-479-0790
  • Fax: 708-479-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. PHILLIP D NARCISSI
Title or Position: DOCTOR
Credential: DPM
Phone: 708-479-0790