Healthcare Provider Details

I. General information

NPI: 1023920949
Provider Name (Legal Business Name): PRIME PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1S132 SUMMIT AVE STE 205
OAKBROOK TERRACE IL
60181-3940
US

IV. Provider business mailing address

870 PAT CT
AURORA IL
60504-5367
US

V. Phone/Fax

Practice location:
  • Phone: 630-358-9908
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: HARIS BHATTI
Title or Position: ASSOCIATE
Credential: DPM
Phone: 630-901-7183