Provider Demographics
NPI:1821032103
Name:LAURA J PICKARD DPM PC
Entity Type:Organization
Organization Name:LAURA J PICKARD DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-625-2211
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 1:7325 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3547
Practice Address - Country:US
Practice Address - Phone:773-625-2211
Practice Address - Fax:773-625-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213658Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILU17265Medicare UPIN
ILK28130Medicare PIN