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NPI Code Detail

MEDICARE: THE FOOT PHYSICIANS LLC

MEDICARE: THE FOOT PHYSICIANS 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
1213E00000XPodiatrist016004344IL

General Provider Information

NPI Number : 1750567160
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE FOOT PHYSICIANS LLC
Provider Business Mailing Address
First Line : 331 N RANDALL RD
Second Line :
City : LAKE IN THE HILLS
State : IL
Zip : 60156-5961
Country : US
Telephone Number : 847-854-8637
Fax Number : 847-854-6779
Provider Business Practice Location Address
First Line : 331 N RANDALL RD
Second Line :
City : LAKE IN THE HILLS
State : IL
Zip : 60156-5961
Country : US
Telephone Number : 847-854-8637
Fax Number : 847-854-6779
Authorized Official
Title or Position : DOCTOR
Name : JEANNIE M WASCHOW
Credential : D.P.M.
Telephone Number : 847-854-8637
Provider Enumeration Date : 01/15/2008
Last Update Date : 09/23/2011

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Directions to “THE FOOT PHYSICIANS LLC ” Practice Location

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