Basic Information
| Provider Information | |||||||||
| NPI: | 1972783413 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR JAMES D VELARDE S.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 N CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | BENSENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601062009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302381111 | ||||||||
| FaxNumber: | 6302380164 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 N CHURCH RD | ||||||||
| Address2: | |||||||||
| City: | BENSENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601062009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302381111 | ||||||||
| FaxNumber: | 6302380164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | VELARDRE | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PODIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 6302381111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 016003948 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.