Provider Demographics
NPI:1952798548
Name:SPECIALIZED PODIATRY, L.L.C.
Entity Type:Organization
Organization Name:SPECIALIZED PODIATRY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKAREVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:224-381-9438
Mailing Address - Street 1:660 DUNHILL DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1513
Mailing Address - Country:US
Mailing Address - Phone:224-381-9438
Mailing Address - Fax:
Practice Address - Street 1:660 DUNHILL DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1513
Practice Address - Country:US
Practice Address - Phone:224-381-9438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005409213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty