Provider Demographics
NPI:1750567160
Name:THE FOOT PHYSICIANS LLC
Entity type:Organization
Organization Name:THE FOOT PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WASCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-854-8637
Mailing Address - Street 1:331 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5961
Mailing Address - Country:US
Mailing Address - Phone:847-854-8637
Mailing Address - Fax:847-854-6779
Practice Address - Street 1:331 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5961
Practice Address - Country:US
Practice Address - Phone:847-854-8637
Practice Address - Fax:847-854-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004344213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1105330001Medicare NSC
ILT91787Medicare UPIN