Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 016-004871 | IL |
Y | 222Z00000X | Podiatrist | 016-004871 | IL |
NPI | 1023125127 |
---|---|
Provider Name | Todd J Karas |
First Address | Peoria, IL 61615-3860 |
Second Address | Peoria, IL 61615-3860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 03/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016004871 | (05) | IL |
016004871 | BLUE SHIELD PIN (01) | IL |
P00114681 | PALMETTO RR MEDICARE PIN (01) | |
U77443 | (02) |