Provider Demographics
NPI:1821692898
Name:PODIATRIC MANAGEMENT SYSTEMS LLC
Entity Type:Organization
Organization Name:PODIATRIC MANAGEMENT SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CHARNOTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-540-9949
Mailing Address - Street 1:70 E LAKE ST STE 1102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7499
Mailing Address - Country:US
Mailing Address - Phone:312-372-1160
Mailing Address - Fax:
Practice Address - Street 1:117 W LAKE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1006
Practice Address - Country:US
Practice Address - Phone:630-582-3338
Practice Address - Fax:630-582-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty