Individual
DR. TODD LEE DIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1415 E REELFOOT AVE, UNION CITY, TN 38261-5812
(731) 885-0220
(731) 885-0216
Mailing address
1415 E REELFOOT AVE, UNION CITY, TN 38261-5812
(731) 885-0220
(731) 885-0216
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
734
TN
213ES0131X
Foot Surgery Podiatrist
016-004761
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016-004-761
—
IL
01
—
09206992
BCBS INSURANCE
IL
01
—
480019679
PALMETTO - MEDICARE
IL
Enumeration date
11/15/2006
Last updated
05/02/2013
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