Provider Demographics
NPI:1043386469
Name:FOOT AND ANKLE WELLNESS CENTER AT SEVEN BRIDGES PC
Entity Type:Organization
Organization Name:FOOT AND ANKLE WELLNESS CENTER AT SEVEN BRIDGES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:VEKKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-852-8522
Mailing Address - Street 1:3540 SEVEN BRIDGES DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1221
Mailing Address - Country:US
Mailing Address - Phone:630-852-8522
Mailing Address - Fax:630-541-2214
Practice Address - Street 1:3540 SEVEN BRIDGES DR
Practice Address - Street 2:SUITE 290
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1221
Practice Address - Country:US
Practice Address - Phone:630-852-8522
Practice Address - Fax:630-541-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003413213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003413Medicaid
IL4910850001Medicare NSC
IL206704Medicare PIN
IL016003413Medicaid
IL1326032871Medicare PIN