Healthcare Provider Details

I. General information

NPI: 1124028477
Provider Name (Legal Business Name): JAMES P FLOOD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 05/18/2025
Certification Date: 05/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W LIBERTY ST
WAUCONDA IL
60084-2467
US

IV. Provider business mailing address

9400 S CICERO AVE STE 100
OAK LAWN IL
60453-2536
US

V. Phone/Fax

Practice location:
  • Phone: 847-487-2827
  • Fax: 847-487-2860
Mailing address:
  • Phone: 708-424-3201
  • Fax: 708-424-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004254
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: