Provider Demographics
NPI:1528078243
Name:ARONOFF, OLGA (DPM)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:ARONOFF
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:RADOVSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:5600 N SHERIDAN RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4877
Mailing Address - Country:US
Mailing Address - Phone:773-769-3310
Mailing Address - Fax:773-769-3398
Practice Address - Street 1:5600 N SHERIDAN RD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4877
Practice Address - Country:US
Practice Address - Phone:773-769-3310
Practice Address - Fax:773-769-3398
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004875213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004875Medicaid
ILK17627Medicare ID - Type UnspecifiedPROV ID WITH GR ID 211671
IL490100Medicare ID - Type UnspecifiedIND PROVIDER ID