Provider Demographics
NPI:1003103045
Name:PASCHOLD, BRYCE ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:ANDREW
Last Name:PASCHOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20054 N 1000 EAST RD
Mailing Address - Street 2:
Mailing Address - City:CARLOCK
Mailing Address - State:IL
Mailing Address - Zip Code:61725-9568
Mailing Address - Country:US
Mailing Address - Phone:309-242-3333
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000742213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery