Provider Demographics
NPI:1649253097
Name:SAKEVICH, TARA L (DPM)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:SAKEVICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 S COUNTY LINE RD
Mailing Address - Street 2:7TH FLOOR - PODIATRY DEPARTMENT
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6376
Mailing Address - Country:US
Mailing Address - Phone:773-372-3282
Mailing Address - Fax:
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:7TH FLOOR - PODIATRY DEPARTMENT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-7264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005128213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-005128Medicaid
IL7346657OtherAETNA
ILP00235061OtherRR MEDICARE
IL7346657OtherAETNA
IL016-005128Medicaid