MEDICARE: LEWIS P CARROZZA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	16002973	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1128610001	OTHER	IL	DMERC
2	60001033	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588612527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEWIS P CARROZZA DPM

Provider Business Mailing Address
First Line	:	4417 147TH ST
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-2643
Country	:	US
Telephone Number	:	708-388-3910
Fax Number	:	708-388-3911

Provider Business Practice Location Address
First Line	:	4417 147TH ST
Second Line	:
City	:	MIDLOTHIAN
State	:	IL
Zip	:	60445-2643
Country	:	US
Telephone Number	:	708-388-3910
Fax Number	:	708-388-3911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/12/2013

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Directions to “ LEWIS P CARROZZA DPM” Practice Location

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