Provider Demographics
NPI:1245429802
Name:CHARO, NITET (DPM)
Entity Type:Individual
Prefix:DR
First Name:NITET
Middle Name:
Last Name:CHARO
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 1:30 E 15TH ST
Mailing Address - Street 2:#206
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3459
Mailing Address - Country:US
Mailing Address - Phone:708-755-7871
Mailing Address - Fax:708-756-3263
Practice Address - Street 1:30 E 15TH ST
Practice Address - Street 2:#206
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3459
Practice Address - Country:US
Practice Address - Phone:708-755-7871
Practice Address - Fax:708-756-3263
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004955213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004955Medicaid
IL01625973OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL480030086OtherRAILROAD MEDICARE
IL016004955Medicaid
IL01625973OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
U79679Medicare UPIN