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General NPI Number Information
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NPI Number | 1063731461
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Entity Type | Organization
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Legal Business Name | LORD FOOT & ANKLE SPECIALIST SC
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 269 W ELK TRL
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City | CAROL STREAM
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State | IL
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Zip | 60188-9373
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Country | US
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Telephone | 630-681-1173
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Fax | 630-868-3948
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Provider Business Mailing Address
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Address Line | 269 W ELK TRL
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City | CAROL STREAM
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State | IL
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Zip | 60188-9373
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Country | US
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Telephone | 630-681-1173
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Fax | 630-868-3948
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Authorized Official
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Title or Position | OWNER
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Name | JAMES R LORD
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Credential | DPM
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Telephone | 630-291-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-004900
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License Number State | IL
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