Provider Demographics
NPI:1760433734
Name:PICKARD, LAURA JANINE (DPM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JANINE
Last Name:PICKARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7325 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3547
Mailing Address - Country:US
Mailing Address - Phone:773-625-2211
Mailing Address - Fax:773-625-2255
Practice Address - Street 1:303 N KEENE ST
Practice Address - Street 2:STE 301
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8053
Practice Address - Country:US
Practice Address - Phone:573-882-8000
Practice Address - Fax:573-882-6600
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004430213E00000X
MO2017000763213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist