Provider Demographics
NPI:1205848975
Name:CHARNOTA, DAVID ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:CHARNOTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:765 ELA ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2339
Mailing Address - Country:US
Mailing Address - Phone:847-540-9949
Mailing Address - Fax:847-540-9971
Practice Address - Street 1:765 ELA ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2339
Practice Address - Country:US
Practice Address - Phone:847-540-9949
Practice Address - Fax:847-540-9971
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003264213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480003019OtherRAILROAD MEDICARE
IL0332890001Medicare NSC
ILT37987Medicare UPIN
IL480003019OtherRAILROAD MEDICARE