Provider Demographics
NPI:1821481755
Name:RPS SURGICAL LTD
Entity Type:Organization
Organization Name:RPS SURGICAL LTD
Other - Org Name:JOSEPH T FANARA DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:FANARA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-332-5222
Mailing Address - Street 1:1617 TEMPLE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61112-1045
Mailing Address - Country:US
Mailing Address - Phone:815-332-5222
Mailing Address - Fax:815-332-5223
Practice Address - Street 1:1617 TEMPLE LN
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61112-1045
Practice Address - Country:US
Practice Address - Phone:815-332-5222
Practice Address - Fax:815-332-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004607213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU41699Medicare UPIN