Healthcare Provider Details

I. General information

NPI: 1457302986
Provider Name (Legal Business Name): PETER G CHIOROS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 N CALIFORNIA AVE STE. 804
CHICAGO IL
60625-7014
US

IV. Provider business mailing address

2740 W FOSTER AVE LL7
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-907-7750
  • Fax: 773-907-7760
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016003834
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: