Healthcare Provider Details

I. General information

NPI: 1265651905
Provider Name (Legal Business Name): CAYETANO PUZON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 N SHERIDAN RD
CHICAGO IL
60640-2514
US

IV. Provider business mailing address

2 E OAK ST APT 3601
CHICAGO IL
60611-6203
US

V. Phone/Fax

Practice location:
  • Phone: 773-769-8165
  • Fax: 773-769-8167
Mailing address:
  • Phone: 312-642-2236
  • Fax: 312-642-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number016004484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: