Provider Demographics
NPI:1366995136
Name:ALLIANCE FOOT & ANKLE CLINICS LLC
Entity type:Organization
Organization Name:ALLIANCE FOOT & ANKLE CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:JON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-282-7209
Mailing Address - Street 1:2640 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-2615
Mailing Address - Country:US
Mailing Address - Phone:847-746-2922
Mailing Address - Fax:847-746-9344
Practice Address - Street 1:2640 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2615
Practice Address - Country:US
Practice Address - Phone:847-746-2922
Practice Address - Fax:847-746-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005682213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7232550002Medicare NSC