Provider Demographics
NPI:1013386135
Name:ILLINOIS FOOT AND ANKLE CENTER, S.C.
Entity Type:Organization
Organization Name:ILLINOIS FOOT AND ANKLE CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:779-333-7419
Mailing Address - Street 1:9645 LINCOLNWAY LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1866
Mailing Address - Country:US
Mailing Address - Phone:779-333-7419
Mailing Address - Fax:779-333-7460
Practice Address - Street 1:9645 LINCOLNWAY LN
Practice Address - Street 2:SUITE 104
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1866
Practice Address - Country:US
Practice Address - Phone:779-333-7419
Practice Address - Fax:779-333-7460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005616213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty