NPIMap

Organization Active NPI

Foot and Ankle Podiatric and Orthopedic Care

  • Foot & Ankle Surgery Podiatrist
  • Frankfort, IL
National Provider Identifier
1760829287
Registry record updated May 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016-005096 Issued in IL
Legal business name
FOOT AND ANKLE PODIATRIC AND ORTHOPEDIC CARE
Practice address
11450 Tea Tree LN
Frankfort, IL 60423-5102
Phone
(815) 312-3885
NPI assigned
May 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2013

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

Authorized official

Name
Dr. Monif Matouk
Title
President
Phone
(815) 312-3885

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X 016-005096 IL Primary

Addresses

Primary practice location

11450 Tea Tree LN
Frankfort, IL 60423-5102

Mailing address

11450 Tea Tree LN
Frankfort, IL 60423-5102
Phone (815) 312-3885

Other identifiers 1

IdentifierTypeStateIssuer
016005096MedicaidIL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1369267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369267200000",
    "number": "1760829287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11450 TEA TREE LN",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604235102",
            "telephone_number": "815-312-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11450 TEA TREE LN",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604235102",
            "telephone_number": "815-312-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT AND ANKLE PODIATRIC AND ORTHOPEDIC CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-23",
        "last_updated": "2013-05-23",
        "status": "A",
        "authorized_official_last_name": "MATOUK",
        "authorized_official_first_name": "MONIF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-312-3885",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016-005096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016005096",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Frankfort, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2013; 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.