Provider Demographics
NPI:1528250669
Name:PREMIER PODIATRY SERVICES, LTD
Entity type:Organization
Organization Name:PREMIER PODIATRY SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PAHOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-866-9800
Mailing Address - Street 1:7126 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-2234
Mailing Address - Country:US
Mailing Address - Phone:773-866-9800
Mailing Address - Fax:773-866-1733
Practice Address - Street 1:7126 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-2234
Practice Address - Country:US
Practice Address - Phone:773-866-9800
Practice Address - Fax:773-866-1733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1208030001OtherADMINISTAR
IL016004340Medicaid
IL0001623503OtherBCBS
ILCG8029OtherRAILROAD MEDICARE
IL5410292OtherCIGNA
IL0001623503OtherBCBS
IL5410292OtherCIGNA