Provider Demographics
NPI:1285015578
Name:FOOT AND ANKLE PAIN CLINIC CORPORATION
Entity Type:Organization
Organization Name:FOOT AND ANKLE PAIN CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-659-9000
Mailing Address - Street 1:10401 GREAT EGRET DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8581
Mailing Address - Country:US
Mailing Address - Phone:708-206-0777
Mailing Address - Fax:708-206-0702
Practice Address - Street 1:3313 45TH ST
Practice Address - Street 2:STE M
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3294
Practice Address - Country:US
Practice Address - Phone:219-924-1042
Practice Address - Fax:219-924-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000921A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1503Medicare PIN