Provider Demographics
NPI:1205037751
Name:PETER J CHIACULAS DPM PC
Entity Type:Organization
Organization Name:PETER J CHIACULAS DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIACULAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-581-9762
Mailing Address - Street 1:129 E VALLETTE STREET
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4477
Mailing Address - Country:US
Mailing Address - Phone:847-581-9762
Mailing Address - Fax:
Practice Address - Street 1:129 E VALLETTE STREET
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4477
Practice Address - Country:US
Practice Address - Phone:847-581-9762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL317900Medicare ID - Type Unspecified
T36292Medicare UPIN