# LIBERTYVILLE ANKLE & FOOT CLINIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487630406
- **Authorized official:** SCOTT A JACOBSEN DPM (OWNER)
- **Authorized official phone:** (847) 362-1320

## Contact information

- **Practice address:** 1017 W PARK AVE, SUITE A, LIBERTYVILLE, IL 60048-2502
- **Practice address phone:** (847) 362-1320
- **Practice address fax:** (847) 362-1823
- **Mailing address:** 1017 W PARK AVE, SUITE A, LIBERTYVILLE, IL 60048-2502
- **Mailing address phone:** (847) 362-1320
- **Mailing address fax:** (847) 362-1823

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 016-005031 | IL | Yes |

## Other

- **Enumeration date:** 12/21/2005
- **Last updated:** 07/25/2014