Healthcare Provider Details

I. General information

NPI: 1346057841
Provider Name (Legal Business Name): 1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WIMBLEDON SQ STE F
CHESAPEAKE VA
23320-4945
US

IV. Provider business mailing address

1660 FEEHANVILLE DR STE 450
MOUNT PROSPECT IL
60056-6023
US

V. Phone/Fax

Practice location:
  • Phone: 757-698-4177
  • Fax: 757-698-4176
Mailing address:
  • Phone: 847-390-7666
  • Fax: 224-220-9345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW C DAIRMAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 757-934-0768