Provider Demographics
NPI:1447276928
Name:TOREN, DONNA J
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:TOREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 N MASON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3187
Mailing Address - Country:US
Mailing Address - Phone:773-685-8666
Mailing Address - Fax:773-775-8487
Practice Address - Street 1:4825 N MASON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3187
Practice Address - Country:US
Practice Address - Phone:773-685-8666
Practice Address - Fax:773-775-8487
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003158213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003158Medicaid
IL60021218OtherBC & BS IL
ILL75834Medicare PIN
ILP16054Medicare PIN
ILL75835Medicare PIN
IL016003158Medicaid
T37722Medicare UPIN
IL480013328Medicare PIN
ILL75836Medicare PIN
IL674831Medicare ID - Type UnspecifiedOFFICE PRACTICE D TOREN