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General NPI Number Information
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NPI Number | 1003103045
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Entity Type | Individual
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Provider Name | BRYCE ANDREW PASCHOLD D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-4254
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Fax |
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Provider Business Mailing Address
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Address Line | 20054 N 1000 EAST RD
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City | CARLOCK
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State | IL
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Zip | 61725-9568
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Country | US
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Telephone | 309-242-3333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005562
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 016005562
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 135000742
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License Number State | IL
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