MEDICARE: FOX VALLEY FOOT CARE, PC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF7609	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04532405	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1568546349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOX VALLEY FOOT CARE, PC

Provider Business Mailing Address
First Line	:	460 BRIARGATE DR
Second Line	:	SUITE 300
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2227
Country	:	US
Telephone Number	:	847-697-3668
Fax Number	:	847-697-3662

Provider Business Practice Location Address
First Line	:	460 BRIARGATE DR
Second Line	:	SUITE 300
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-2227
Country	:	US
Telephone Number	:	847-697-3668
Fax Number	:	847-697-3662

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD R MOTOS
Credential	:	DPM
Telephone Number	:	847-697-3668

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	10/08/2007

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Directions to “FOX VALLEY FOOT CARE, PC ” Practice Location

Language	Start Address	Practice Location

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