Provider Demographics
NPI:1316931157
Name:BUIVIDAS, THOMAS ANTHONY (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:BUIVIDAS
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 1:4554 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-2954
Mailing Address - Country:US
Mailing Address - Phone:773-847-6784
Mailing Address - Fax:773-847-6883
Practice Address - Street 1:4554 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2954
Practice Address - Country:US
Practice Address - Phone:773-847-6784
Practice Address - Fax:773-847-6883
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T37627Medicare UPIN
666840Medicare ID - Type Unspecified