Provider Demographics
NPI:1427783224
Name:NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD
Entity type:Organization
Organization Name:NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCENEANEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-639-5800
Mailing Address - Street 1:750 E TERRA COTTA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3621
Mailing Address - Country:US
Mailing Address - Phone:847-639-5800
Mailing Address - Fax:
Practice Address - Street 1:3540 SEVEN BRIDGES DR STE 290
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1289
Practice Address - Country:US
Practice Address - Phone:847-639-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN ILLINOIS FOOT AND ANKLE SPECIALIST, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty