Healthcare Provider Details

I. General information

NPI: 1699871509
Provider Name (Legal Business Name): LEWIS P CARROZZA DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 147TH ST
MIDLOTHIAN IL
60445-2643
US

IV. Provider business mailing address

4417 147TH ST
MIDLOTHIAN IL
60445-2643
US

V. Phone/Fax

Practice location:
  • Phone: 708-388-3910
  • Fax: 708-388-3911
Mailing address:
  • Phone: 708-388-3910
  • Fax: 708-388-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LEWIS P CARROZZA
Title or Position: OWNER
Credential: DPM
Phone: 708-388-3910