MEDICARE: FOOT & ANKLE CENTER, 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	016005263	IL

General Provider Information

NPI Number	:	1790795904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT & ANKLE CENTER, LLC

Provider Business Mailing Address
First Line	:	1299 REAVIS BARRACKS RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63125-3260
Country	:	US
Telephone Number	:	314-487-9300
Fax Number	:	314-487-9338

Provider Business Practice Location Address
First Line	:	957 LINCOLN HWY
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2234
Country	:	US
Telephone Number	:	618-632-4885
Fax Number	:	618-632-0350

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LOUIS AQUINO
Credential	:	DPM, FACFAS
Telephone Number	:	314-487-9300

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/09/2008

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Directions to “FOOT & ANKLE CENTER, LLC ” Practice Location

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