Healthcare Provider Details

I. General information

NPI: 1366003451
Provider Name (Legal Business Name): PARISE PREFERRED PODIATRY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 11/20/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W NORTH AVE STE 409
MELROSE PARK IL
60160-1624
US

IV. Provider business mailing address

675 W NORTH AVE STE 104
MELROSE PARK IL
60160-1622
US

V. Phone/Fax

Practice location:
  • Phone: 773-208-4443
  • Fax:
Mailing address:
  • Phone: 773-208-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL PARISE
Title or Position: OWNER OF GROUP
Credential: DPM
Phone: 773-208-4443