Provider Demographics
NPI:1770363467
Name:EAGLE-SUMMIT FOOT & ANKLE, P.C.
Entity type:Organization
Organization Name:EAGLE-SUMMIT FOOT & ANKLE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JULEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-902-0457
Mailing Address - Street 1:3701 ALGONQUIN RD STE 470
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3152
Mailing Address - Country:US
Mailing Address - Phone:888-453-0080
Mailing Address - Fax:224-732-1399
Practice Address - Street 1:842 SUMMIT BLVD UNIT 15
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-5882
Practice Address - Country:US
Practice Address - Phone:970-668-4565
Practice Address - Fax:970-668-4566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE-SUMMIT FOOT & ANKLE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-02
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty