Provider Demographics
NPI:1891172664
Name:FOOT AND ANKLE SPECIALISTS OF ILLINOIS LTD
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF ILLINOIS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZEHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDERI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-660-6060
Mailing Address - Street 1:2430 ESPLANADE DRIVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102
Mailing Address - Country:US
Mailing Address - Phone:847-854-8000
Mailing Address - Fax:
Practice Address - Street 1:2430 ESPLANADE DRIVE SUITE A
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102
Practice Address - Country:US
Practice Address - Phone:847-854-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty