Provider Demographics
NPI:1457302986
Name:CHIOROS, PETER G (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:G
Last Name:CHIOROS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:5215 N CALIFORNIA AVE
Practice Address - Street 2:STE. 804
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7014
Practice Address - Country:US
Practice Address - Phone:773-907-7750
Practice Address - Fax:773-907-7760
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003834213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400111859OtherPTAN
IL60001533OtherBLUE CROSS BLUE SHIELD
IL480016126OtherMEDICARE RAILROAD
IL016003834Medicaid
F400111859OtherPTAN