Provider Demographics
NPI:1598058547
Name:FOOT & ANKLE CENTER OF ILLINOIS PC
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTER OF ILLINOIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:217-787-2700
Mailing Address - Street 1:2921 MONTVALE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-5359
Mailing Address - Country:US
Mailing Address - Phone:217-787-2700
Mailing Address - Fax:217-787-2715
Practice Address - Street 1:2921 MONTVALE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-5359
Practice Address - Country:US
Practice Address - Phone:217-787-2700
Practice Address - Fax:217-787-2715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005201213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005201Medicaid
P00145756OtherRAILROAD MEDICARE