Organization
PRAIRIE ROCK FOOT & ANKLE CLINIC LTD
Active
Other names
Manteno Foot & Ankle Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALENE D LESAGE CMA (OFFICE MANAGER)
(815) 468-7117
Entity
Organization
Contact information
Practice address
2825 WEST DIVISION STREET, MANTENO, IL 60950-1518
(815) 468-7117
(815) 468-7510
Mailing address
2825 WEST DIVISION STREET, MANTENO, IL 60950-1518
(815) 468-7117
(815) 468-7510
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203799
MEDICARE GROUP NUMBER
IL
01
—
480034698
RAILROAD MEDICARE
IL
Enumeration date
12/27/2005
Last updated
07/21/2022
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