MEDICARE: AUR PODIATRY DPM INC

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E5265	CA

General Provider Information

NPI Number	:	1790201077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUR PODIATRY DPM INC

Provider Business Mailing Address
First Line	:	1810 GRAND CANAL BLVD STE 2
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-8110
Country	:	US
Telephone Number	:	209-952-1612
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 GRAND CANAL BLVD STE 2
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-8110
Country	:	US
Telephone Number	:	209-952-1612
Fax Number	:	209-952-1631

Authorized Official
Title or Position	:	PODIATRIST
Name	:	RADIN AUR
Credential	:	DPM
Telephone Number	:	847-406-9192

Provider Enumeration Date	:	08/17/2017
Last Update Date	:	02/27/2020

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