| Organization Name: | FOX LAKE FOOT CARE LTD |
| NPI Number: | 1699053967 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TEGAN A THIMESCH (DOCTOR) |
| Mailing Address: | 214 Washington St Suite #3 Ingleside |
| State: | IL US |
| Postal Code: | 600419208 |
| Phone Number: | 8475873221 |
| Fax Number: | 8475872148 |
| NPI Enumeration Date: | 08/03/2011 |
| NPI Last Update Date: | 08/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 016003998 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |