Healthcare Provider Details

I. General information

NPI: 1619915790
Provider Name (Legal Business Name): PASCHAL U OPARAH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7845 S COTTAGE GROVE AVE 108
CHICAGO IL
60619-3100
US

IV. Provider business mailing address

7845 S COTTAGE GROVE AVE 108
CHICAGO IL
60619-3100
US

V. Phone/Fax

Practice location:
  • Phone: 773-224-3500
  • Fax: 773-224-5837
Mailing address:
  • Phone: 773-224-3500
  • Fax: 773-224-5837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number16004576
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: