Healthcare Provider Details

I. General information

NPI: 1881860906
Provider Name (Legal Business Name): TAMMY LOUISE GALIZIA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SKOKIE BLVD STE 520
NORTHBROOK IL
60062-1601
US

IV. Provider business mailing address

PO BOX 917
NORTHBROOK IL
60065-0917
US

V. Phone/Fax

Practice location:
  • Phone: 847-504-5000
  • Fax: 847-504-5015
Mailing address:
  • Phone: 847-504-5000
  • Fax: 847-504-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number959-025
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016005315
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: