Provider Demographics
NPI:1730267659
Name:FOOT AND ANKLE CARE, LTD.
Entity type:Organization
Organization Name:FOOT AND ANKLE CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-479-6460
Mailing Address - Street 1:11308 DISTINCTIVE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9459
Mailing Address - Country:US
Mailing Address - Phone:708-479-6460
Mailing Address - Fax:708-479-6462
Practice Address - Street 1:11308 DISTINCTIVE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9459
Practice Address - Country:US
Practice Address - Phone:708-479-6460
Practice Address - Fax:708-479-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004283213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT87138Medicare UPIN
IL4685020001Medicare NSC
IL212901Medicare ID - Type Unspecified