Healthcare Provider Details

I. General information

NPI: 1912276684
Provider Name (Legal Business Name): MOBILE FOOT DOCTORS, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 07/11/2020
Certification Date: 07/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 KIRCHOFF RD
ROLLING MEADOWS IL
60008-2005
US

IV. Provider business mailing address

4215 KIRCHOFF RD
ROLLING MEADOWS IL
60008-2005
US

V. Phone/Fax

Practice location:
  • Phone: 847-231-2517
  • Fax: 847-789-7202
Mailing address:
  • Phone: 847-231-2517
  • Fax: 847-789-7202

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 Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER J LEE
Title or Position: PRESIDENT
Credential:
Phone: 847-231-2517