Provider Demographics
NPI:1598954471
Name:FOOT & ANKLE PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:FOOT & ANKLE PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-957-3338
Mailing Address - Street 1:17500 E CARRIAGEWAY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2057
Mailing Address - Country:US
Mailing Address - Phone:708-957-3338
Mailing Address - Fax:708-957-4555
Practice Address - Street 1:17500 E CARRIAGEWAY DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2057
Practice Address - Country:US
Practice Address - Phone:708-957-3338
Practice Address - Fax:708-957-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty