MEDICARE: WEIL FOOT AND ANKLE INSTITUTE LLC

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
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1609506229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEIL FOOT AND ANKLE INSTITUTE LLC

Provider Business Mailing Address
First Line	:	1660 FEEHANVILLE DR STE 450
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-6023
Country	:	US
Telephone Number	:	847-390-7666
Fax Number	:	847-390-9345

Provider Business Practice Location Address
First Line	:	10255 SOUTHWEST HWY
Second Line	:
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-1350
Country	:	US
Telephone Number	:	847-390-7666
Fax Number	:	847-390-9345

Authorized Official
Title or Position	:	CEO
Name	:	LOWELL SCOTT WEIL
Credential	:	DPM
Telephone Number	:	847-390-7666

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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