Provider Demographics
NPI:1962796631
Name:PARISE, DANIEL MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:MICHAEL
Last Name:PARISE
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 1:675 W NORTH AVE
Mailing Address - Street 2:STE 409
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1624
Mailing Address - Country:US
Mailing Address - Phone:312-852-2525
Mailing Address - Fax:866-446-6140
Practice Address - Street 1:675 W NORTH AVE STE 409
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1624
Practice Address - Country:US
Practice Address - Phone:312-852-2525
Practice Address - Fax:949-404-8351
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3872213ES0131X
IL016005839213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I486153Medicare PIN