MEDICARE: DR. THOMAS ANTHONY BUIVIDAS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist		IL

General Provider Information

NPI Number	:	1316931157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ANTHONY BUIVIDAS DPM

Provider Business Mailing Address
First Line	:	4554 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2954
Country	:	US
Telephone Number	:	773-847-6784
Fax Number	:	773-847-6883

Provider Business Practice Location Address
First Line	:	4554 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2954
Country	:	US
Telephone Number	:	773-847-6784
Fax Number	:	773-847-6883

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/08/2007

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