Provider Demographics
NPI:1124028477
Name:FLOOD, JAMES PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:PATRICK
Last Name:FLOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2467
Mailing Address - Country:US
Mailing Address - Phone:847-487-2827
Mailing Address - Fax:847-416-4900
Practice Address - Street 1:385 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-2467
Practice Address - Country:US
Practice Address - Phone:847-487-2827
Practice Address - Fax:847-487-2860
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004254213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4723640001Medicare NSC
ILK37696Medicare PIN
IL215729Medicare PIN
ILT92916Medicare UPIN