=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679760821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOOT AND ANKLE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2007
-----------------------------------------------------
Last Update Date | 10/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14539 S STIRRUP CT
-----------------------------------------------------
City | HOMER GLEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60491-9297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-276-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14539 S STIRRUP CT
-----------------------------------------------------
City | HOMER GLEN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60491-9297
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-276-4600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ATIYEH A SALEM
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 773-276-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------