Provider Demographics
NPI:1699053967
Name:FOX LAKE FOOT CARE LTD
Entity type:Organization
Organization Name:FOX LAKE FOOT CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TEGAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:THIMESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-587-3221
Mailing Address - Street 1:214 WASHINGTON ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-9208
Mailing Address - Country:US
Mailing Address - Phone:847-587-3221
Mailing Address - Fax:847-587-2148
Practice Address - Street 1:214 WASHINGTON ST
Practice Address - Street 2:SUITE #3
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-9208
Practice Address - Country:US
Practice Address - Phone:847-587-3221
Practice Address - Fax:847-587-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003998213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty