Provider Demographics
NPI:1487860698
Name:SUBURBAN FOOT & ANKLE ASSOCIATES INC
Entity type:Organization
Organization Name:SUBURBAN FOOT & ANKLE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-226-9860
Mailing Address - Street 1:215 REMINGTON BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3657
Mailing Address - Country:US
Mailing Address - Phone:630-226-9860
Mailing Address - Fax:630-312-8662
Practice Address - Street 1:215 REMINGTON BLVD STE A2
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3657
Practice Address - Country:US
Practice Address - Phone:630-226-9860
Practice Address - Fax:630-312-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004455213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09922757OtherBCBS OF IL
IL6460800001Medicare NSC
ILU33618Medicare UPIN
IL211795Medicare PIN