Provider Demographics
NPI:1952615114
Name:MCLEAN FOOT CLINIC PC
Entity type:Organization
Organization Name:MCLEAN FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRSHAD
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-931-7066
Mailing Address - Street 1:552 N MCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-3242
Mailing Address - Country:US
Mailing Address - Phone:847-931-7066
Mailing Address - Fax:847-931-7726
Practice Address - Street 1:552 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-3242
Practice Address - Country:US
Practice Address - Phone:847-931-7066
Practice Address - Fax:847-931-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004398261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4974490002Medicare NSC