MEDICARE: NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, 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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1477192755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD

Provider Business Mailing Address
First Line	:	750 E TERRA COTTA AVE STE C
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-3621
Country	:	US
Telephone Number	:	847-639-5800
Fax Number	:	815-526-3467

Provider Business Practice Location Address
First Line	:	6780 N NORTHWEST HWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1242
Country	:	US
Telephone Number	:	847-639-5800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICK ALLEN MCENEANEY
Credential	:	DPM
Telephone Number	:	847-639-5800

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	06/10/2020

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