Provider Demographics
NPI:1063154565
Name:UNIVERSAL PODIATRY LLC
Entity type:Organization
Organization Name:UNIVERSAL PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:646-281-6984
Mailing Address - Street 1:4554 N AVERS AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6306
Mailing Address - Country:US
Mailing Address - Phone:646-281-6984
Mailing Address - Fax:
Practice Address - Street 1:4554 N AVERS AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6306
Practice Address - Country:US
Practice Address - Phone:646-281-6984
Practice Address - Fax:773-942-7523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty