Provider Demographics
NPI:1639270663
Name:ELGIN FOOT & ANKLE CENTER, S.C.
Entity Type:Organization
Organization Name:ELGIN FOOT & ANKLE CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-741-3127
Mailing Address - Street 1:750 FLETCHER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4703
Mailing Address - Country:US
Mailing Address - Phone:847-741-3127
Mailing Address - Fax:847-741-3173
Practice Address - Street 1:750 FLETCHER DR STE 300
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-741-3127
Practice Address - Fax:847-741-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDD0562OtherRAILROAD MEDICARE
IL5432480001Medicare NSC
IL211462Medicare ID - Type Unspecified