Provider Demographics
NPI:1154498194
Name:CENTER FOR FOOT AND ANKLE SURGERY LTD
Entity Type:Organization
Organization Name:CENTER FOR FOOT AND ANKLE SURGERY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-553-9300
Mailing Address - Street 1:654 W VETERANS PKWY
Mailing Address - Street 2:STE D
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4567
Mailing Address - Country:US
Mailing Address - Phone:630-553-9300
Mailing Address - Fax:630-553-9306
Practice Address - Street 1:1802 DIVISION ST
Practice Address - Street 2:STE 305
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450
Practice Address - Country:US
Practice Address - Phone:815-942-9050
Practice Address - Fax:815-942-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL16004810213ES0103X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
541430Medicare ID - Type Unspecified
IL1295330001Medicare NSC