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General NPI Number Information
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NPI Number | 1063154565
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Entity Type | Organization
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Legal Business Name | UNIVERSAL PODIATRY LLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 1515 N HARLEM AVE STE 100
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City | OAK PARK
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State | IL
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Zip | 60302-1205
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Country | US
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Telephone | 708-628-2398
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Fax | 708-628-2402
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Provider Business Mailing Address
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Address Line | 4554 N AVERS AVE # 2
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City | CHICAGO
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State | IL
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Zip | 60625-6306
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Country | US
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Telephone | 646-281-6984
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Fax |
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Authorized Official
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Title or Position | DPM / OWNER
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Name | DARLA THOMAS
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Credential | DPM
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Telephone | 708-957-3338
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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 |
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License Number State |
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