Provider Demographics
NPI:1932454279
Name:PODOMEDIK CLINICS LLC.
Entity Type:Organization
Organization Name:PODOMEDIK CLINICS LLC.
Other - Org Name:GERARDO PEREZ SINGLE MEMBER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ ESPINDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:414-719-4799
Mailing Address - Street 1:159 N GREENLEAF ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3341
Mailing Address - Country:US
Mailing Address - Phone:847-249-3888
Mailing Address - Fax:847-574-7477
Practice Address - Street 1:159 N GREENLEAF ST STE 1
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3341
Practice Address - Country:US
Practice Address - Phone:847-249-3888
Practice Address - Fax:847-574-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005265261QP1100X
WI91125261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005265Medicaid
WI43241500Medicaid
WIWI1874OtherMEDICARE PTAN
ILIL4062OtherMEDICARE PTAN
WI1932454279OtherGROUP NPI
ILIL4062OtherMEDICARE PTAN
WIWI1874OtherMEDICARE PTAN
WIWI1874OtherMEDICARE PTAN
WI43241500Medicaid