Provider Demographics
NPI:1407039944
Name:J & J FOOT CLINICS, LTD.
Entity Type:Organization
Organization Name:J & J FOOT CLINICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-364-1917
Mailing Address - Street 1:6 TIGER CT
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-2052
Mailing Address - Country:US
Mailing Address - Phone:630-364-1917
Mailing Address - Fax:
Practice Address - Street 1:6 TIGER CT
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60490-2052
Practice Address - Country:US
Practice Address - Phone:630-364-1917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL66718Medicare PIN
U72631Medicare UPIN