Healthcare Provider Details

I. General information

NPI: 1760433734
Provider Name (Legal Business Name): LAURA JANINE PICKARD DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N KEENE ST STE 301
COLUMBIA MO
65201-8053
US

IV. Provider business mailing address

7325 W IRVING PARK RD
CHICAGO IL
60634-3547
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-8000
  • Fax: 573-882-6600
Mailing address:
  • Phone: 773-625-2211
  • Fax: 773-625-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004430
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2017000763
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: