Provider Demographics
NPI:1578729638
Name:ANKLE AND FOOT CENTER OF FOX VALLEY, LTD.
Entity Type:Organization
Organization Name:ANKLE AND FOOT CENTER OF FOX VALLEY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAGODZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-778-7670
Mailing Address - Street 1:620 N. RIVER RD.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8951
Mailing Address - Country:US
Mailing Address - Phone:630-778-7670
Mailing Address - Fax:630-778-7671
Practice Address - Street 1:620 N. RIVER RD.
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8951
Practice Address - Country:US
Practice Address - Phone:630-778-7670
Practice Address - Fax:630-778-7671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004352213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL911051Medicare UPIN
ILT87168Medicare UPIN
IL911051Medicare PIN