=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669703344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NAPERVILLE FOOT AND ANKLE SPECIALISTS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2010
-----------------------------------------------------
Last Update Date | 01/20/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9S157 ROUTE 59
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-9427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-904-6666
-----------------------------------------------------
Fax | 815-436-8367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 678
-----------------------------------------------------
City | PLAINFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60544-0678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-254-3338
-----------------------------------------------------
Fax | 815-436-8367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SPECIALIST
-----------------------------------------------------
Name | MS. MICHELE N KUKULSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 815-254-3338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 016-004798
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------