Provider Demographics
NPI:1588836134
Name:ALPINE FOOT SPECIALIST PC
Entity Type:Organization
Organization Name:ALPINE FOOT SPECIALIST PC
Other - Org Name:ALPINE FOOT SPECIALISTS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-540-9949
Mailing Address - Street 1:765 ELA ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2339
Mailing Address - Country:US
Mailing Address - Phone:847-540-9949
Mailing Address - Fax:847-540-9971
Practice Address - Street 1:765 ELA ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2339
Practice Address - Country:US
Practice Address - Phone:847-540-9949
Practice Address - Fax:847-540-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003264332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCL8623OtherRAILROAD MEDICARE
IL480003019OtherRAILROAD MEDICARE
IL480003019OtherRAILROAD MEDICARE
ILT37987Medicare UPIN
IL700131Medicare PIN