Provider Demographics
NPI:1790336584
Name:ANKLE AND FOOT SURGERY LLC
Entity Type:Organization
Organization Name:ANKLE AND FOOT SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-228-6543
Mailing Address - Street 1:800 BIESTERFIELD RD STE 207
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3378
Mailing Address - Country:US
Mailing Address - Phone:847-228-6543
Mailing Address - Fax:
Practice Address - Street 1:800 BIESTERFIELD RD STE 207
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3378
Practice Address - Country:US
Practice Address - Phone:847-228-6543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center