Provider Demographics
NPI:1427111392
Name:ALL FAMILY FOOT AND ANKLE LTD
Entity type:Organization
Organization Name:ALL FAMILY FOOT AND ANKLE LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-863-6303
Mailing Address - Street 1:2124 S AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2012
Mailing Address - Country:US
Mailing Address - Phone:708-863-5376
Mailing Address - Fax:708-863-5375
Practice Address - Street 1:2124 S AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2012
Practice Address - Country:US
Practice Address - Phone:708-863-5376
Practice Address - Fax:708-863-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-000475213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL406480247OtherRAILROAD MEDICARE
IL60000161OtherBLUE CROSS BLUE SHIELD
IL406480247OtherRAILROAD MEDICARE
IL60000161OtherBLUE CROSS BLUE SHIELD