Provider Demographics
NPI:1104941574
Name:FAMILY FOOT AND ANKLE CARE, P.C.
Entity type:Organization
Organization Name:FAMILY FOOT AND ANKLE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:DORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-739-6610
Mailing Address - Street 1:550 E BOUGHTON RD STE 195
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-2194
Mailing Address - Country:US
Mailing Address - Phone:630-739-6610
Mailing Address - Fax:630-410-2482
Practice Address - Street 1:550 E BOUGHTON RD STE 195
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2194
Practice Address - Country:US
Practice Address - Phone:630-739-6610
Practice Address - Fax:630-410-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5899020001Medicare NSC