Healthcare Provider Details

I. General information

NPI: 1962796631
Provider Name (Legal Business Name): DANIEL MICHAEL PARISE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2011
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 409
MELROSE PARK IL
60160-1624
US

V. Phone/Fax

Practice location:
  • Phone: 312-852-2525
  • Fax: 949-404-8351
Mailing address:
  • Phone: 312-852-2525
  • Fax: 866-446-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005839
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO3872
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: