Provider Demographics
NPI:1851405716
Name:FOX VALLEY PODIATRISTS OF MCHENRY COUNTY
Entity Type:Organization
Organization Name:FOX VALLEY PODIATRISTS OF MCHENRY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:HECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-788-8680
Mailing Address - Street 1:650 DAKOTA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-3744
Mailing Address - Country:US
Mailing Address - Phone:815-788-8680
Mailing Address - Fax:815-788-8746
Practice Address - Street 1:650 DAKOTA ST
Practice Address - Street 2:SUITE B
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-3744
Practice Address - Country:US
Practice Address - Phone:815-788-8680
Practice Address - Fax:815-788-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X, 213E00000X, 213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5632093OtherBCBS
ILU93569Medicare UPIN
IL207755Medicare ID - Type Unspecified
IL5632093OtherBCBS
ILK02452Medicare UPIN
ILU51924Medicare UPIN
ILK02453Medicare UPIN
ILK02964Medicare UPIN
ILT02272Medicare UPIN
ILK02454Medicare UPIN