Provider Demographics
NPI:1699707240
Name:CHIAKMAKIS, JOHN G (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:CHIAKMAKIS
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 1:5000 E MEDITERRANEAN DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2422
Mailing Address - Country:US
Mailing Address - Phone:520-417-2244
Mailing Address - Fax:520-459-0487
Practice Address - Street 1:5000 E MEDITERRANEAN DR
Practice Address - Street 2:SUITE D
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2422
Practice Address - Country:US
Practice Address - Phone:520-417-2244
Practice Address - Fax:520-459-0487
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0158220OtherBLUE CROSS BLUE SHIELD
AZP00276895OtherMEDICARE RAILROAD
AZAZ0158220OtherBLUE CROSS BLUE SHIELD
AZZ107733Medicare PIN
AZ5621950001Medicare NSC