Provider Demographics
NPI:1073704672
Name:DES PLAINES VALLEY FOOT CARE INC
Entity Type:Organization
Organization Name:DES PLAINES VALLEY FOOT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-838-3669
Mailing Address - Street 1:123 E 9TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3690
Mailing Address - Country:US
Mailing Address - Phone:815-838-3668
Mailing Address - Fax:
Practice Address - Street 1:123 E 9TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3690
Practice Address - Country:US
Practice Address - Phone:815-838-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005231213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932699OtherBLUE CROSS BLUE SHIELD
IL6002250001Medicare NSC
IL212527Medicare PIN