Provider Demographics
NPI:1588830913
Name:PHILLIP D. NARCISSI DPM S.C.
Entity Type:Organization
Organization Name:PHILLIP D. NARCISSI DPM S.C.
Other - Org Name:MOKENA FOOT AND ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NARCISSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-479-0790
Mailing Address - Street 1:19841 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1315
Mailing Address - Country:US
Mailing Address - Phone:708-479-0790
Mailing Address - Fax:
Practice Address - Street 1:19841 WOLF RD
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1315
Practice Address - Country:US
Practice Address - Phone:708-479-0790
Practice Address - Fax:708-479-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004628213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherCHAMPUS
ILIL2878Medicare PIN