Provider Demographics
NPI:1578709184
Name:PODOMEDIK CLINICS
Entity Type:Organization
Organization Name:PODOMEDIK CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-ESPINDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:856-520-4513
Mailing Address - Street 1:425 SHORELAND DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3829
Mailing Address - Country:US
Mailing Address - Phone:847-249-3888
Mailing Address - Fax:
Practice Address - Street 1:425 SHORELAND DR
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3829
Practice Address - Country:US
Practice Address - Phone:847-249-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI911-025213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000082039OtherMEDICARE PTAN
WI000082037OtherMEDICARE PTAN
IL215839OtherMEDICARE PTAN