Provider Demographics
NPI:1295925899
Name:IL FOOT & ANKLE CLINIC MEDICAL CORP
Entity type:Organization
Organization Name:IL FOOT & ANKLE CLINIC MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:YANOVSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-298-3338
Mailing Address - Street 1:1400 E GOLF RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-8821
Mailing Address - Country:US
Mailing Address - Phone:773-614-3302
Mailing Address - Fax:847-906-1092
Practice Address - Street 1:1400 E GOLF RD STE 201
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-8821
Practice Address - Country:US
Practice Address - Phone:847-298-3338
Practice Address - Fax:847-298-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005284213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005284Medicaid
IL016005284Medicaid