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Organization Active NPI

Jeffrey S Boberg DPM LLC

Doing business as Ankle & Foot Surgeons of the Midwest

  • Foot & Ankle Surgery Podiatrist
  • Belleville, IL
National Provider Identifier
1710147236
Registry record updated Jul 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016004233 Issued in IL
Legal business name
JEFFREY S BOBERG DPM LLC
Doing business as
Ankle & Foot Surgeons of the Midwest
Practice address
180 S 3Rd St
Ste 103
Belleville, IL 62220-1952
Phone
(618) 236-7444
NPI assigned
Jun 10, 2008
Last updated
Jul 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jeffrey S Boberg, DPM
Title
Owner/Physician
Phone
(618) 236-7444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 016004233 IL Primary

Addresses

Primary practice location

180 S 3Rd St
Ste 103
Belleville, IL 62220-1952

Mailing address

180 S 3Rd St
Ste 103
Belleville, IL 62220-1952
Phone (618) 236-7444

Other names 1

  • Ankle & Foot Surgeons of the Midwest Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216252800000",
    "number": "1710147236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S 3RD ST",
            "address_2": "STE 103",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201952",
            "telephone_number": "618-236-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 S 3RD ST",
            "address_2": "STE 103",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201952",
            "telephone_number": "618-236-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFREY S BOBERG DPM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-10",
        "last_updated": "2008-07-17",
        "status": "A",
        "authorized_official_last_name": "BOBERG",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "618-236-7444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016004233",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ankle & Foot Surgeons of the Midwest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.