Provider Demographics
NPI:1447262597
Name:HANDY, MYRA (DPM)
Entity type:Individual
Prefix:DR
First Name:MYRA
Middle Name:
Last Name:HANDY
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:PO BOX 496957
Mailing Address - Street 2:2337 EAST 71ST STREET
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649
Mailing Address - Country:US
Mailing Address - Phone:773-643-2250
Mailing Address - Fax:773-643-4290
Practice Address - Street 1:2337 EAST 71ST STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649
Practice Address - Country:US
Practice Address - Phone:773-643-2250
Practice Address - Fax:773-643-4290
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635155OtherBCBS
5271970001OtherDMERC
T38943Medicare UPIN
5271970001OtherDMERC