Provider Demographics
NPI:1013389840
Name:PEARL PODIATRY HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:PEARL PODIATRY HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACHIMIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:303-442-2910
Mailing Address - Street 1:27087 GRATIOT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-2947
Mailing Address - Country:US
Mailing Address - Phone:586-498-9440
Mailing Address - Fax:586-498-9460
Practice Address - Street 1:2575 PEARL ST
Practice Address - Street 2:SUITE #240
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-3868
Practice Address - Country:US
Practice Address - Phone:303-442-2910
Practice Address - Fax:303-442-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center