Provider Demographics
NPI:1063731461
Name:LORD FOOT & ANKLE SPECIALIST SC
Entity type:Organization
Organization Name:LORD FOOT & ANKLE SPECIALIST SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-291-6060
Mailing Address - Street 1:269 W ELK TRL
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9373
Mailing Address - Country:US
Mailing Address - Phone:630-681-1173
Mailing Address - Fax:630-868-3948
Practice Address - Street 1:269 W ELK TRL
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9373
Practice Address - Country:US
Practice Address - Phone:630-681-1173
Practice Address - Fax:630-868-3948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4170Medicare PIN