Provider Demographics
NPI:1043999642
Name:FOOT AND WOUND INSTITUTE LLC
Entity Type:Organization
Organization Name:FOOT AND WOUND INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKOLIE
Authorized Official - Suffix:
Authorized Official - Credentials:NPC
Authorized Official - Phone:708-271-3537
Mailing Address - Street 1:475 DOXBURY LN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3454
Mailing Address - Country:US
Mailing Address - Phone:708-271-3537
Mailing Address - Fax:
Practice Address - Street 1:475 DOXBURY LN
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3454
Practice Address - Country:US
Practice Address - Phone:708-271-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty