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General NPI Number Information
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NPI Number | 1285817536
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Entity Type | Organization
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Legal Business Name | FOX VALLEY FOOT AND ANKLE SPECIALIST, LTD
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 2401 KANEVILLE RD STE 6
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City | GENEVA
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State | IL
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Zip | 60134-2577
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Country | US
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Telephone | 630-232-1013
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Fax | 630-232-1014
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Provider Business Mailing Address
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Address Line | PO BOX 762
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City | GENEVA
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State | IL
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Zip | 60134-0762
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Country | US
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Telephone | 630-232-1013
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Fax | 630-232-1014
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK MONDUL
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Credential |
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Telephone | 630-232-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016003529
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License Number State | IL
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