MEDICARE: ALL FAMILY FOOT AND ANKLE LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	060-000475	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	406480247	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	60000161	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1427111392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL FAMILY FOOT AND ANKLE LTD

Provider Business Mailing Address
First Line	:	2124 S AUSTIN BLVD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2012
Country	:	US
Telephone Number	:	708-863-5376
Fax Number	:	708-863-5375

Provider Business Practice Location Address
First Line	:	2124 S AUSTIN BLVD
Second Line	:
City	:	CICERO
State	:	IL
Zip	:	60804-2012
Country	:	US
Telephone Number	:	708-863-5376
Fax Number	:	708-863-5375

Authorized Official
Title or Position	:	PRESIDENT/DOCTOR
Name	:	LAURA M. LEBEAU
Credential	:	D.P.M.
Telephone Number	:	708-863-6303

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	09/01/2010

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Practice Location Address:

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1881699080 — DR. MANISH I DESAI D.O.
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1457351629 — DR. PAUL STEVEN SIMMONS D.D.S., M.S.
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Practice Location Address:

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1912994054 — MS. NAVEED HYDERI PA-C
Practice Location Address:

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Practice Fax:

Directions to “ALL FAMILY FOOT AND ANKLE LTD ” Practice Location

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