Basic Information
| Provider Information | |||||||||
| NPI: | 1720728876 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALPINE FOOT SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 765 ELA RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAKE ZURICH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600472339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475409949 | ||||||||
| FaxNumber: | 8475409971 | ||||||||
| Practice Location | |||||||||
| Address1: | 765 ELA RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAKE ZURICH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600472339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475409949 | ||||||||
| FaxNumber: | 8475409971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2022 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | GURRERA | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8475409949 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 03/16/2022 | ||||||||
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.