Divan, Todd Lee

Divan, Todd Lee is an sole proprietor health care provider with primary practice located at 1415 E Reelfoot Ave , Union City TN 38261-5812. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Foot Surgery, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is his primary health care specialty. Divan, Todd Lee can be contacted via phone (731) 885-0220.

Contact Information

Primary practice address
1415 E Reelfoot Ave Union City TN 38261-5812
Phone: (731) 885-0220
Fax: (731) 885-0216
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X 016-004761 Illinois
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 734 Tennessee

Profile Details

NPI number 1235201898
LBN Legal business name Divan, Todd Lee
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 15th, 2006
Last updated May 2nd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235201898 NPPES
Illinois MEDICAID 016-004-761
Illinois Other 480019679
Illinois Other 09206992

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