| Professional Foot & Ankle Llc | |
|
231 Main St, Park Forest, IL 60466-2097 | |
| (708) 749-3338 | |
| (708) 748-4332 |
| Full Name | Professional Foot & Ankle Llc |
|---|---|
| Type | Facility |
| Speciality | Podiatrist |
| Location | 231 Main St, Park Forest, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467606152 | NPI | - | NPPES |
| 4632153 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213E00000X | Podiatrist | 016005113 (Illinois) | Primary |
| Provider Name | Jerome R Randall |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1376689257 PECOS PAC ID: 1759281868 Enrollment ID: I20040113000440 |
| Provider Name | Haytham Mansour |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1811078207 PECOS PAC ID: 6204902489 Enrollment ID: I20080912000157 |
| Provider Name | Ramin Ghazizadeh |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1649652140 PECOS PAC ID: 2567771363 Enrollment ID: I20180503000021 |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Foot & Ankle Llc Po Box 1889, Matteson, IL 60443-4889 Ph: (708) 250-0785 | Professional Foot & Ankle Llc 231 Main St, Park Forest, IL 60466-2097 Ph: (708) 749-3338 |
Dennis J Wolny Dpm Pc Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 251 Founders Way, Park Forest, IL 60466 Phone: 708-748-6292 Fax: 708-748-6988 | |
Dr. Jerome R Randall Jr., DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 231 Main St, Park Forest, IL 60466 Phone: 708-748-3338 Fax: 708-748-4332 | |
Charlotte M Covello Dpm Llc Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 231 Main St, Park Forest, IL 60466 Phone: 708-748-3338 Fax: 708-748-4332 | |
Dr. Dennis J Wolny, DPM PC Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 251 Founders Way, Park Forest, IL 60466 Phone: 708-748-6292 Fax: 708-748-6988 | |
Ramin Ghazizadeh, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 231 Main St, Park Forest, IL 60466 Phone: 708-748-3338 Fax: 708-748-4332 | |
Ramin Ghazizadeh Llc Podiatrist Medicare: Medicare Enrolled Practice Location: 231 Main St, Park Forest, IL 60466 Phone: 708-748-3338 Fax: 708-748-4332 |