1972391241 NPI number — NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD

Table of content: KATELYN MUSTAIN BIANCONI R.D. (NPI 1740602796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972391241 NPI number — NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN ILLINOIS FOOT & ANKLE SPECIALISTS, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972391241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 E TERRA COTTA AVE STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL LAKE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60014-3621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-671-4515
Provider Business Mailing Address Fax Number:
815-671-4515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
608 HILLGROVE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERN SPRINGS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60558-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-639-5800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MCENEANEY
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDEN/CEO
Authorized Official Telephone Number:
847-639-5800

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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