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MOON'S MULTI SPECIALTY CLINIC SC NPI 1245208453


NPI Information

NPI: 1245208453
Provider Name: MOON'S MULTI SPECIALTY CLINIC, SC

Former Legal Business Name: MOON'S FOOT AND ANKLE CLINIC, SC

Classification: Podiatrist - 213E00000X
Entity Type: Organization
Address:
270 CENTER DR
SUITE 120
VERNON HILLS, IL
ZIP 60061
Phone: (847) 573-1157
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MOON'S MULTI SPECIALTY CLINIC, SC is a podiatrist in Vernon Hills, IL. The provider is a podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. MOON'S MULTI SPECIALTY CLINIC, SC NPI is 1245208453. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Moon's Foot And Ankle Clinic, Sc.

The provider's business location address is:

270 CENTER DR
SUITE 120
VERNON HILLS, IL
ZIP 60061-564
Phone: (847) 573-1157
Fax: (224) 513-5458

The provider's authorized official is Jung Moon .
The authorized official title is Owner and has the following contact phone number (847) 573-1157.

The enumeration date for this NPI number is 3/14/2006 and was last updated on 4/11/2014.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213E00000XPodiatrist016-004899ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14932398OTHERILLINOISBCBSIL
2211072MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
35338400001MEDICARE NSCILLINOIS
4V04047MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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