Provider Demographics
NPI:1023125127
Name:KARAS, TODD J (DPM)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:J
Last Name:KARAS
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 1:4507 N STERLING AVE
Mailing Address - Street 2:#102
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3860
Mailing Address - Country:US
Mailing Address - Phone:309-272-7322
Mailing Address - Fax:309-272-2251
Practice Address - Street 1:4507 N STERLING AVE
Practice Address - Street 2:#102
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3860
Practice Address - Country:US
Practice Address - Phone:309-272-7322
Practice Address - Fax:309-272-2251
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004871213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004871Medicaid
P00114681OtherPALMETTO RR MEDICARE PIN
IL016004871OtherBLUE SHIELD PIN
P00114681OtherPALMETTO RR MEDICARE PIN
K05248Medicare ID - Type Unspecified
IL016004871Medicaid