Provider Demographics
NPI:1801918164
Name:TODD J KARAS DPM PC
Entity type:Organization
Organization Name:TODD J KARAS DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENATA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KARAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-272-7322
Mailing Address - Street 1:4507 N STERLING AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3860
Mailing Address - Country:US
Mailing Address - Phone:309-272-7322
Mailing Address - Fax:309-272-2251
Practice Address - Street 1:4507 N STERLING AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-3860
Practice Address - Country:US
Practice Address - Phone:309-272-7322
Practice Address - Fax:309-272-2251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060008364213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004871Medicaid
P00114681OtherPALMETTO RR PIN
IL0007232085OtherBLUE SHIELD GROUP
P00114681OtherPALMETTO RR PIN
208700Medicare PIN
IL5062840001Medicare NSC