person
Dr. Todd Lee Divan, DPM
Foot & Ankle Surgery Podiatrist in Union City, Tennessee
NPI 1235201898

Todd Lee Divan is a Foot & Ankle Surgery Podiatrist based in Union City, TN and is specialized in Foot & Ankle Surgery. Todd Lee Divan practices in Union City, TN and has the professional credentials of DPM. The NPI Number for Todd Lee Divan is 1235201898 and holds a License No. 016-004761 (Tennessee).

The current practice location address for Todd Lee Divan is 1415 E Reelfoot Ave, Union City, TN and can be reached out via phone at 731-885-0220 and via fax at 731-885-0216.

Location: 1415 E Reelfoot Ave, Union City, TN, 38261-5812
person
Provider Profile Details
NPI Number
1235201898
Provider Name
Todd Lee Divan
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
1415 E Reelfoot Ave, Union City, TN, 38261-5812
Phone Number
731-885-0220
Fax Number
731-885-0216
Provider Enumeration Date
11/15/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
016-004-761 05 IL
480019679 01 IL PALMETTO - MEDICARE
09206992 01 IL BCBS INSURANCE
institution
Provider Business Practice Location Address Details
Address
1415 E Reelfoot Ave
City
State
Zip
38261-5812
Phone Number
731-885-0220
Fax Number
731-885-0216
person
Provider Business Mailing Address Details
Address
1415 E Reelfoot Ave
City
State
Zip
38261-5812
Phone Number
731-885-0220
Fax Number
731-885-0216
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
License No.
734 (Tennessee)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot Surgery
Taxonomy
License No.
016-004761 (Illinois)
Definition
Definition to come...
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