Basic Information
| Provider Information | |||||||||
| NPI: | 1700872595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURANOSKY | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 PAYSPHERE CIR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606740018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304699200 | ||||||||
| FaxNumber: | 6302459098 | ||||||||
| Practice Location | |||||||||
| Address1: | 1259 RICKERT DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305106929 | ||||||||
| FaxNumber: | 6308511756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 06/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 016004820 | IL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0000X | 016004820 | IL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Sports Medicine | 213ES0103X | 016004820 | IL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 016004820 | IL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213E00000X | 016004820 | IL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 016004820 | 05 | IL | MEDICAID | 200027778 | 01 | IL | RAILROAD MEDICARE | OTHER |