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	:	1972391241
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	:	815-671-4515
Fax Number	:	815-671-4515

Provider Business Practice Location Address
First Line	:	608 HILLGROVE AVE
Second Line	:
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-1476
Country	:	US
Telephone Number	:	847-639-5800
Fax Number	:

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

Provider Enumeration Date	:	04/28/2025
Last Update Date	:	04/28/2025

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