Individual
DR. THOMAS DANIEL PAHOLAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
12786 LASALLE LN, HUNTINGTON WOODS, MI 48070-1020
(248) 572-3900
(248) 572-1277
Mailing address
6374 N LINCOLN AVE STE 303, CHICAGO, IL 60659-1283
(773) 866-9800
(773) 866-1733
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016004340
IL
213E00000X
Podiatrist
Primary
5901001714
MI
213ES0131X
Foot Surgery Podiatrist
016-004340
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001623503
BCBS
IL
01
—
016-004340
IL STATE LICENSE
IL
05
—
016-004340
—
IL
01
—
480027688
RAILROAD MEDICARE
IL
Enumeration date
05/30/2006
Last updated
03/23/2022
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