Provider Demographics
NPI:1386854610
Name:FOOT AND ANKLE SPECIALISTS, PC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VOHRA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-254-3338
Mailing Address - Street 1:24039 W LOCKPORT ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-1652
Mailing Address - Country:US
Mailing Address - Phone:815-254-3338
Mailing Address - Fax:815-436-8367
Practice Address - Street 1:24039 W LOCKPORT ST
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-1652
Practice Address - Country:US
Practice Address - Phone:815-254-3338
Practice Address - Fax:815-436-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004798213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL009908116OtherBCBS PROVIDER LEGACY ID
IL480023719OtherRAILROAD MEDICARE
IL009908116OtherBCBS PROVIDER LEGACY ID
IL245080Medicare ID - Type Unspecified