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General NPI Number Information
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NPI Number | 1831209519
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Entity Type | Organization
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Legal Business Name | ILLIANA FOOT & ANKLE SPECIALISTS, P.C.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 425 US ROUTE 30 STE 400
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City | DYER
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State | IN
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Zip | 46311-1768
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Country | US
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Telephone | 219-864-3204
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Fax | 219-864-3211
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Provider Business Mailing Address
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Address Line | 425 US ROUTE 30 STE 400
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City | DYER
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State | IN
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Zip | 46311-1768
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Country | US
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Telephone | 219-864-3204
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Fax | 219-864-3211
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JOHN P RACHOY
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Credential | DPM
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Telephone | 219-864-3204
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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 | 07000920A
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License Number State | IN
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