=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588329429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT & ANKLE ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2021
-----------------------------------------------------
Last Update Date | 05/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 WALNUT ST
-----------------------------------------------------
City | LAWRENCEBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47025-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-537-4848
-----------------------------------------------------
Fax | 812-537-4373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9400 S CICERO AVE STE 100
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-2536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-424-3201
-----------------------------------------------------
Fax | 708-424-5001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | NICKOLAS A MINNIE
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 513-844-8585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------