Provider Demographics
NPI:1497224950
Name:NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD
Entity Type:Organization
Organization Name:NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-639-5800
Mailing Address - Street 1:1288 S US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:FOX LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60020-1950
Mailing Address - Country:US
Mailing Address - Phone:847-639-5800
Mailing Address - Fax:847-639-2980
Practice Address - Street 1:1288 S US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1950
Practice Address - Country:US
Practice Address - Phone:847-639-5800
Practice Address - Fax:847-639-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty