Provider Demographics
NPI:1255575510
Name:NATIONAL ATHLETIC ANKLE AND FOOT INSTITUTE, SC
Entity type:Organization
Organization Name:NATIONAL ATHLETIC ANKLE AND FOOT INSTITUTE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-515-1711
Mailing Address - Street 1:2425 W 22ND ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1245
Mailing Address - Country:US
Mailing Address - Phone:630-515-1711
Mailing Address - Fax:800-790-6813
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:SUITE 208
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1245
Practice Address - Country:US
Practice Address - Phone:630-515-1711
Practice Address - Fax:800-790-6813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004539213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty