Provider Demographics
NPI:1275676975
Name:KACHIGIAN, ARMAND (DPM)
Entity Type:Individual
Prefix:
First Name:ARMAND
Middle Name:
Last Name:KACHIGIAN
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 1:2860 STATE ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-3610
Mailing Address - Country:US
Mailing Address - Phone:618-616-4412
Mailing Address - Fax:
Practice Address - Street 1:103 W VANDALIA ST
Practice Address - Street 2:STE 100
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1958
Practice Address - Country:US
Practice Address - Phone:323-371-8348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4055213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4055Medicare PIN