Organization
PREMIER PODIATRY SERVICES, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS DANIEL PAHOLAK DPM (PRESIDENT)
(773) 866-9800
Entity
Organization
Contact information
Practice address
7126 N LINCOLN AVE, LINCOLNWOOD, IL 60712-2234
(773) 866-9800
(773) 866-1733
Mailing address
7126 N LINCOLN AVE, LINCOLNWOOD, IL 60712-2234
(773) 866-9800
(773) 866-1733
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001623503
BCBS
IL
05
—
016004340
—
IL
01
—
1208030001
ADMINISTAR
IL
01
—
5410292
CIGNA
IL
01
—
CG8029
RAILROAD MEDICARE
IL
Enumeration date
08/13/2007
Last updated
04/25/2023
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