Provider Demographics
NPI:1972618635
Name:CHIARAMONTE, BRIAN JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:CHIARAMONTE
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:7060 CENTENNIAL DR
Mailing Address - Street 2:STE 105
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1699
Mailing Address - Country:US
Mailing Address - Phone:773-579-1440
Mailing Address - Fax:773-579-0227
Practice Address - Street 1:3303 S HALSTED ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6705
Practice Address - Country:US
Practice Address - Phone:773-579-1440
Practice Address - Fax:773-579-0227
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2018-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL016-004502213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004502Medicaid
ILU11083Medicare UPIN
IL940690Medicare PIN