MEDICARE: DR. THOMAS DANIEL PAHOLAK 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	016004340	IL
2	213ES0131X	Foot Surgery Podiatrist	016-004340	IL
3	213E00000X	Podiatrist	5901001714	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	480027688	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016-004340	OTHER	IL	IL STATE LICENSE
2	0001623503	OTHER	IL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710934955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS DANIEL PAHOLAK DPM

Provider Business Mailing Address
First Line	:	6374 N LINCOLN AVE STE 303
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1283
Country	:	US
Telephone Number	:	773-866-9800
Fax Number	:	773-866-1733

Provider Business Practice Location Address
First Line	:	12786 LASALLE LN
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1020
Country	:	US
Telephone Number	:	248-572-3900
Fax Number	:	248-572-1277

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	03/23/2022

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