Provider Demographics
NPI:1740518307
Name:HMI FOOT AND ANKLE GROUP, SC
Entity type:Organization
Organization Name:HMI FOOT AND ANKLE GROUP, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYTHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, PHD
Authorized Official - Phone:630-656-3171
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-0711
Mailing Address - Country:US
Mailing Address - Phone:630-656-3171
Mailing Address - Fax:630-657-0131
Practice Address - Street 1:19255 EVERETT LN
Practice Address - Street 2:SUITE B
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8958
Practice Address - Country:US
Practice Address - Phone:630-656-3171
Practice Address - Fax:630-657-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005301213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2964Medicare PIN