Provider Demographics
NPI:1144472523
Name:BOCHAT, SUMMER EVALYN SCHAAL (DPM)
Entity type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:EVALYN SCHAAL
Last Name:BOCHAT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E TERRA COTTA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3621
Mailing Address - Country:US
Mailing Address - Phone:847-639-5800
Mailing Address - Fax:847-475-9031
Practice Address - Street 1:750 E TERRA COTTA AVE STE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3621
Practice Address - Country:US
Practice Address - Phone:847-639-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI970-25213ES0103X, 213E00000X
IL016.005355213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43260300Medicaid
WI100004663Medicaid
1417141227OtherNPI
1144472523OtherNPI
WI100004663Medicaid
WI000046034Medicare PIN
WI6066690002Medicare NSC
WI460340003Medicare PIN