Provider Demographics
NPI:1619915790
Name:OPARAH, PASCHAL U (DPM)
Entity Type:Individual
Prefix:
First Name:PASCHAL
Middle Name:U
Last Name:OPARAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7845 S COTTAGE GROVE AVE
Mailing Address - Street 2:108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3100
Mailing Address - Country:US
Mailing Address - Phone:773-224-3500
Mailing Address - Fax:773-224-5837
Practice Address - Street 1:7845 S COTTAGE GROVE AVE
Practice Address - Street 2:108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3100
Practice Address - Country:US
Practice Address - Phone:773-224-3500
Practice Address - Fax:773-224-5837
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL16004576213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001762OtherBLUECROSS BLUESHIELD
IL953240Medicare ID - Type Unspecified
ILU20112Medicare UPIN