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Organization

FAMILY FOOT & ANKLE CLINIC PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. STEPHEN KOVACH DPM (PRESIDENT)
(217) 429-1512
Entity
Organization

Contact information

Practice address
1390 N FAIRVIEW AVE, DECATUR, IL 62526-3618
(217) 429-1512
(217) 423-1465
Mailing address
1390 N FAIRVIEW AVE, DECATUR, IL 62526-3618
(217) 429-1512
(217) 423-1465

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
060008117
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
016004984
IL
05
016004985
IL
01
CK6281
RAILROAD MEDICARE -
IL
Enumeration date
01/09/2007
Last updated
02/17/2011
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