Basic Information
| Provider Information | |||||||||
| NPI: | 1699381376 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PODIATRIC MANAGEMENT SYSTEMS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 E LAKE ST STE 1102 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606017499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123721160 | ||||||||
| FaxNumber: | 3123723346 | ||||||||
| Practice Location | |||||||||
| Address1: | 1943 S MANNHEIM RD | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601544322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083523338 | ||||||||
| FaxNumber: | 7083529933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2020 | ||||||||
| LastUpdateDate: | 09/18/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHARNOTA | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8475409949 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 09/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.