Provider Demographics
NPI:1972783413
Name:DR JAMES D VELARDE S.C
Entity Type:Organization
Organization Name:DR JAMES D VELARDE S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:VELARDRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:630-238-1111
Mailing Address - Street 1:165 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-2009
Mailing Address - Country:US
Mailing Address - Phone:630-238-1111
Mailing Address - Fax:630-238-0164
Practice Address - Street 1:165 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-2009
Practice Address - Country:US
Practice Address - Phone:630-238-1111
Practice Address - Fax:630-238-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003948213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4783760001Medicare NSC