Provider Demographics
NPI:1669703344
Name:NAPERVILLE FOOT AND ANKLE SPECIALISTS PC
Entity type:Organization
Organization Name:NAPERVILLE FOOT AND ANKLE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:N
Authorized Official - Last Name:KUKULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-254-3338
Mailing Address - Street 1:PO BOX 678
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0678
Mailing Address - Country:US
Mailing Address - Phone:815-254-3338
Mailing Address - Fax:815-436-8367
Practice Address - Street 1:9S157 ROUTE 59
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9427
Practice Address - Country:US
Practice Address - Phone:630-904-6666
Practice Address - Fax:815-436-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004798213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU59328Medicare UPIN
IL245080Medicare PIN
IL1292920001Medicare NSC