Provider Demographics
NPI:1730323817
Name:ASSOCIATED FOOT AND ANKLE CLINICS, PC
Entity Type:Organization
Organization Name:ASSOCIATED FOOT AND ANKLE CLINICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-672-0280
Mailing Address - Street 1:301 E HICKORY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2287
Mailing Address - Country:US
Mailing Address - Phone:815-672-0280
Mailing Address - Fax:
Practice Address - Street 1:301 E HICKORY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2287
Practice Address - Country:US
Practice Address - Phone:815-672-0280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060007405213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL549000Medicare PIN
IL5305790002Medicare NSC