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General NPI Number Information
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NPI Number | 1881936649
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Entity Type | Organization
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Legal Business Name | PRAIRIE FOOT & ANKLE, P.C.
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Dates
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Enumeration Date | 03/20/2013
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 2371 BOWES ROAD SUITE 400
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 630-715-8291
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Fax |
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Provider Business Mailing Address
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Address Line | 2371 BOWES ROAD STE 400
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 630-715-8291
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DENISE MARY-DANIELLE LEE
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Credential | MM/HRM
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Telephone | 224-227-6973
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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 | 016.005367
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License Number State | IL
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