Provider Demographics
NPI:1558630681
Name:FOOT PHYSICIANS, LLC.
Entity Type:Organization
Organization Name:FOOT PHYSICIANS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-838-3338
Mailing Address - Street 1:795 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1372
Mailing Address - Country:US
Mailing Address - Phone:847-838-3338
Mailing Address - Fax:
Practice Address - Street 1:795 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1372
Practice Address - Country:US
Practice Address - Phone:847-838-3338
Practice Address - Fax:847-854-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004344213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1105330002Medicare NSC