Provider Demographics
NPI:1194043539
Name:TRUE CARE FOOT AND ANKLE INSTITUTE PC
Entity Type:Organization
Organization Name:TRUE CARE FOOT AND ANKLE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIF
Authorized Official - Middle Name:MOUSSA
Authorized Official - Last Name:MATOUK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-534-5724
Mailing Address - Street 1:9500 W LINCOLN HWY
Mailing Address - Street 2:UNIT 6
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1939
Mailing Address - Country:US
Mailing Address - Phone:815-464-4723
Mailing Address - Fax:815-277-2456
Practice Address - Street 1:9500 W LINCOLN HWY
Practice Address - Street 2:UNIT 6
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1939
Practice Address - Country:US
Practice Address - Phone:815-464-4723
Practice Address - Fax:815-277-2456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005096261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005096Medicaid
IL016005096Medicaid
IL6484340001Medicare NSC