Organization
PROFESSIONAL FOOT & ANKLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEROME R RANDALL JR. DPM (MEMBER)
(708) 250-0785
Entity
Organization
Contact information
Practice address
231 MAIN ST, PARK FOREST, IL 60466-2097
(708) 749-3338
(708) 748-4332
Mailing address
PO BOX 1889, MATTESON, IL 60443-4889
(708) 250-0785
(708) 898-2326
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016005113
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4632153
BLUE CROSS BLUE SHIELD
IL
Enumeration date
11/08/2008
Last updated
05/17/2025
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