Provider Demographics
NPI:1679760821
Name:FOOT AND ANKLE INC
Entity type:Organization
Organization Name:FOOT AND ANKLE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATIYEH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-276-4600
Mailing Address - Street 1:14539 S STIRRUP CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9297
Mailing Address - Country:US
Mailing Address - Phone:773-276-4600
Mailing Address - Fax:
Practice Address - Street 1:14539 S STIRRUP CT
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9297
Practice Address - Country:US
Practice Address - Phone:773-276-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty