Provider Demographics
NPI:1790201077
Name:AUR PODIATRY DPM INC
Entity Type:Organization
Organization Name:AUR PODIATRY DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:RADIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-406-9192
Mailing Address - Street 1:1810 GRAND CANAL BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8110
Mailing Address - Country:US
Mailing Address - Phone:209-952-1612
Mailing Address - Fax:
Practice Address - Street 1:1810 GRAND CANAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8110
Practice Address - Country:US
Practice Address - Phone:209-952-1612
Practice Address - Fax:209-952-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5265213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty