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PERFORMANCE FOOT AND ANKLE CENTER LLC NPI 1104004290


NPI Information

NPI: 1104004290
Provider Name: PERFORMANCE FOOT AND ANKLE CENTER LLC
Classification: Podiatrist - 213E00000X
Entity Type: Organization
Address:
15300 WEST AVE
SUITE 210
ORLAND PARK, IL
ZIP 60462
Phone: (708) 873-9440
Get Directions

PERFORMANCE FOOT AND ANKLE CENTER LLC is a podiatrist in Orland Park, IL. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. PERFORMANCE FOOT AND ANKLE CENTER LLC NPI is 1104004290. The provider is registered as an organization entity type.

The provider's business location address is:

15300 WEST AVE
SUITE 210
ORLAND PARK, IL
ZIP 60462-600
Phone: (708) 873-9440
Fax: (708) 873-1862

The provider's authorized official is Dale S Brink .
The authorized official title is Owner and has the following contact phone number (708) 596-3757.

The enumeration date for this NPI number is 1/31/2008 and was last updated on 7/16/2015.


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
1332B00000XDurable Medical Equipment & Medical Supplies5000520001ILLINOISNo
2213E00000XPodiatrist016004747ILLINOISYes

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
15000520001MEDICARE NSCILLINOIS
2207792MEDICARE PIN

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

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