Provider Demographics
NPI:1952718488
Name:MACNAB FOOT AND ANKLE CENTER, PC
Entity Type:Organization
Organization Name:MACNAB FOOT AND ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MACNAB
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:815-725-8400
Mailing Address - Street 1:13645 S CHIPPEWA TRL
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9648
Mailing Address - Country:US
Mailing Address - Phone:708-301-4205
Mailing Address - Fax:
Practice Address - Street 1:330 MADISON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6596
Practice Address - Country:US
Practice Address - Phone:815-725-8400
Practice Address - Fax:815-725-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric