Provider Demographics
NPI:1932300381
Name:CHIACULAS, PETER J (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:CHIACULAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E VALLETTE STREET
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4477
Mailing Address - Country:US
Mailing Address - Phone:847-581-9762
Mailing Address - Fax:
Practice Address - Street 1:129 E VALLETTE STREET
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-4477
Practice Address - Country:US
Practice Address - Phone:847-581-9762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL317900Medicare ID - Type Unspecified
T36292Medicare UPIN