Provider Demographics
NPI:1336389204
Name:FOX VALLEY FOOT SPECIALISTS,LTD.
Entity Type:Organization
Organization Name:FOX VALLEY FOOT SPECIALISTS,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-548-3900
Mailing Address - Street 1:1279 S NAPER BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8300
Mailing Address - Country:US
Mailing Address - Phone:630-548-3900
Mailing Address - Fax:630-548-3905
Practice Address - Street 1:1279 S NAPER BLVD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8300
Practice Address - Country:US
Practice Address - Phone:630-548-3900
Practice Address - Fax:630-548-3905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-007904332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5916070001Medicare NSC