MEDICARE: PARISE PREFERRED PODIATRY CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP1100X	Podiatric Clinic/Center
2	213ES0131X	Foot Surgery Podiatrist

General Provider Information

NPI Number	:	1366003451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARISE PREFERRED PODIATRY CORP

Provider Business Mailing Address
First Line	:	675 W NORTH AVE STE 104
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1622
Country	:	US
Telephone Number	:	773-208-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 W NORTH AVE STE 409
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1624
Country	:	US
Telephone Number	:	773-208-4443
Fax Number	:

Authorized Official
Title or Position	:	OWNER OF GROUP
Name	:	DANIEL PARISE
Credential	:	DPM
Telephone Number	:	773-208-4443

Provider Enumeration Date	:	06/28/2019
Last Update Date	:	11/20/2022

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