Provider Demographics
NPI:1902361769
Name:PODIATRY PROVIDERS LLC
Entity Type:Organization
Organization Name:PODIATRY PROVIDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-370-8362
Mailing Address - Street 1:3118 N SHEFFIELD AVE STE 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-8680
Mailing Address - Country:US
Mailing Address - Phone:773-766-9444
Mailing Address - Fax:
Practice Address - Street 1:3118 N SHEFFIELD AVE STE 1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-8680
Practice Address - Country:US
Practice Address - Phone:773-766-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty