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General NPI Number Information
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NPI Number | 1992959571
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Entity Type | Organization
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Legal Business Name | BLOOMINGDALE FOOT & ANKLE ASSOCIATES, INC
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 129 FAIRFIELD WAY STE 110
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1557
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Country | US
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Telephone | 630-894-3000
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Fax | 630-894-3050
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Provider Business Mailing Address
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Address Line | 129 FAIRFIELD WAY STE 110
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1557
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Country | US
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Telephone | 630-894-3000
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Fax | 630-894-3050
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TINA BOMBARD
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Credential |
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Telephone | 630-897-6851
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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 | 016003453
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License Number State | IL
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