Healthcare Provider Details

I. General information

NPI: 1134703531
Provider Name (Legal Business Name): NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N MAIN ST
WHEATON IL
60187-3583
US

IV. Provider business mailing address

750 E TERRA COTTA AVE STE C
CRYSTAL LAKE IL
60014-3621
US

V. Phone/Fax

Practice location:
  • Phone: 630-538-3668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK ALLEN MCENEANEY
Title or Position: OWNER
Credential:
Phone: 847-639-5800