Provider Demographics
NPI:1831209519
Name:ILLIANA FOOT & ANKLE SPECIALISTS, P.C.
Entity type:Organization
Organization Name:ILLIANA FOOT & ANKLE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RACHOY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-864-3204
Mailing Address - Street 1:425 US ROUTE 30
Mailing Address - Street 2:STE 400
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1768
Mailing Address - Country:US
Mailing Address - Phone:219-864-3204
Mailing Address - Fax:219-864-3211
Practice Address - Street 1:425 US ROUTE 30
Practice Address - Street 2:STE 400
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1768
Practice Address - Country:US
Practice Address - Phone:219-864-3204
Practice Address - Fax:219-864-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000920A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207954Medicare PIN
IN211470Medicare PIN
IN5199290001Medicare NSC