Provider Demographics
NPI:1538512199
Name:AMERICAN FOOT & ANKLE SPECIALISTS, LTD.
Entity Type:Organization
Organization Name:AMERICAN FOOT & ANKLE SPECIALISTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRITI
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUTHENPURAKAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-202-4898
Mailing Address - Street 1:6620 GREENE RD
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1473
Mailing Address - Country:US
Mailing Address - Phone:630-202-4898
Mailing Address - Fax:630-527-6392
Practice Address - Street 1:640 S WASHINGTON ST STE 380
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6787
Practice Address - Country:US
Practice Address - Phone:630-272-6441
Practice Address - Fax:630-527-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005669213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty