Basic Information
| Provider Information | |||||||||
| NPI: | 1477713212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER FOOT & ANKLE PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 N ARLINGTON HEIGHTS RD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600891783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474193939 | ||||||||
| FaxNumber: | 2246760448 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 N ARLINGTON HEIGHTS RD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | BUFFALO GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600891783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474193939 | ||||||||
| FaxNumber: | 2246760448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 08/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | HALINSKI | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8474193939 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 016004807 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 01639893 | 01 | IL | BCBS | OTHER |