Basic Information
| Provider Information | |||||||||
| NPI: | 1376715870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRI-COUNTY FOOT & ANKLE CENTERS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4310 W CRYSTAL LAKE RD STE F | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600504282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153633223 | ||||||||
| FaxNumber: | 8153533240 | ||||||||
| Practice Location | |||||||||
| Address1: | 4310 W CRYSTAL LAKE RD STE F | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600504282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153633223 | ||||||||
| FaxNumber: | 8153533240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2008 | ||||||||
| LastUpdateDate: | 04/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | KHAN | ||||||||
| AuthorizedOfficialFirstName: | IQBAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8153633223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.