PREMIER FOOT AND ANKLE OF ILLINOIS PC NPI 1467867234

NPI Information

NPI: 1467867234
Provider Name: PREMIER FOOT AND ANKLE OF ILLINOIS, PC
Classification: Podiatrist - 213ES0103X
Entity Type: Organization

Specialization: Foot & Ankle Surgery

Address:
6810 STATE ROUTE 162
SUITE 20
MARYVILLE, IL
ZIP 62062
Phone: (618) 288-2835
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PREMIER FOOT AND ANKLE OF ILLINOIS, PC is a foot and ankle surgery podiatrist in Maryville, IL. PREMIER FOOT AND ANKLE OF ILLINOIS, PC NPI is 1467867234. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6810 STATE ROUTE 162
SUITE 20
MARYVILLE, IL
ZIP 62062-587
Phone: (618) 288-2835
Fax: (618) 288-6162

The provider's authorized official is Gabriel Cardenas .
The authorized official title is Owner/podiatrist and has the following contact phone number (618) 288-2835.

The enumeration date for this NPI number is 6/30/2014 and was last updated on 11/18/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213ES0103X	Podiatrist	Foot & Ankle Surgery	016.005608	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	F100153987	OTHER	ILLINOIS	MEDICARE PTAN GROUP
2	1467867234	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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