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Organization
PEACHTREE PODIATRY LLC
Active
Organization
PEACHTREE PODIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREA L PEACH M D (PRESIDENT)
(773) 372-1191
Entity
Organization
Contact information
Practice address
3534 W PALMER ST APT 2, CHICAGO, IL 60647-5699
(773) 372-1191
Mailing address
3534 W PALMER ST APT 2, CHICAGO, IL 60647-5699
(773) 372-1191
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016005323
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016005323
LICENSE
IL
Enumeration date
01/18/2012
Last updated
01/18/2012
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