# PERFORMANCE PODIATRY PARTNERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265942080
- **Authorized official:** DR. SUPNA REILLY DPM (PHYSICIAN)
- **Authorized official phone:** (508) 259-8466

## Contact information

- **Practice address:** 4805 N CLAREMONT AVE, COMMERCIAL UNIT 1, CHICAGO, IL 60625
- **Practice address phone:** (312) 579-3150
- **Mailing address:** 2120 N WINCHESTER AVE, CHICAGO, IL 60614-3915
- **Mailing address phone:** (508) 259-8466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0000X | Sports Medicine Podiatrist | — | NULL | Yes |
| 213ES0000X | Sports Medicine Podiatrist | — | — | Yes |

## Other

- **Enumeration date:** 10/06/2017
- **Last updated:** 10/06/2017