Provider Demographics
NPI:1649319120
Name:DONETS FOOT AND ANKLE PC
Entity type:Organization
Organization Name:DONETS FOOT AND ANKLE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:DONETS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-392-8080
Mailing Address - Street 1:77 S MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3187
Mailing Address - Country:US
Mailing Address - Phone:847-392-8080
Mailing Address - Fax:847-279-0595
Practice Address - Street 1:77 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3187
Practice Address - Country:US
Practice Address - Phone:847-392-8080
Practice Address - Fax:847-392-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
IL016005156213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634235OtherBCBS
IL1649319120Medicaid
IL01634235OtherBCBS
IL1649319120Medicaid