Provider Demographics
NPI:1346752656
Name:PRAIRIE FOOT & ANKLE, P.C.
Entity type:Organization
Organization Name:PRAIRIE FOOT & ANKLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MARY-DANIELLE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:BSHA/MMHRM
Authorized Official - Phone:224-227-6973
Mailing Address - Street 1:7447 W TALCOTT AVE STE 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3715
Mailing Address - Country:US
Mailing Address - Phone:224-227-6973
Mailing Address - Fax:
Practice Address - Street 1:7447 WEST TALCOTT AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60163-3275
Practice Address - Country:US
Practice Address - Phone:224-227-6973
Practice Address - Fax:224-238-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005367213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN