Provider Demographics
NPI:1912190349
Name:DM FOOT AND ANKLE ASSOCIATES LLC
Entity Type:Organization
Organization Name:DM FOOT AND ANKLE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMINI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-863-7517
Mailing Address - Street 1:14236 MCCARTHY RD
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-9393
Mailing Address - Country:US
Mailing Address - Phone:630-863-7517
Mailing Address - Fax:630-863-7519
Practice Address - Street 1:14236 MCCARTHY RD
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-9393
Practice Address - Country:US
Practice Address - Phone:630-863-7517
Practice Address - Fax:630-863-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005312213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3285216OtherCIGNA
IL01638062OtherBLUE CROSS BLUE SHIELD
IL01638062OtherBCBS
IL01638062OtherBLUE CROSS BLUE SHIELD
IL6230330001Medicare NSC