Provider Demographics
NPI:1558310904
Name:PARRILLI, NICHOLAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:PARRILLI
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 1:1228 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2740
Mailing Address - Country:US
Mailing Address - Phone:630-810-9966
Mailing Address - Fax:630-810-9596
Practice Address - Street 1:1228 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2740
Practice Address - Country:US
Practice Address - Phone:630-810-9966
Practice Address - Fax:630-810-9596
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005231213E00000X
IN07001088A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005231Medicaid
IL09932699OtherBLUE CROSS BLUE SHIELD
0732240001OtherDMERC # WITH PPG
ILK46395Medicare PIN
0732240001OtherDMERC # WITH PPG
IL016005231Medicaid
WIP00862657Medicare PIN
IN859800DDMedicare PIN
IL09932699OtherBLUE CROSS BLUE SHIELD
ILK47131Medicare PIN
ILR00540Medicare PIN
ILK46396Medicare PIN