Healthcare Provider Details

I. General information

NPI: 1013570472
Provider Name (Legal Business Name): GAREN AZIZI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2019
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 W BELMONT AVE
CHICAGO IL
60641-4130
US

IV. Provider business mailing address

5501 W BELMONT AVE
CHICAGO IL
60641-4130
US

V. Phone/Fax

Practice location:
  • Phone: 773-205-0106
  • Fax:
Mailing address:
  • Phone: 773-205-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07001401A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number135.001030
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005982
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: