Healthcare Provider Details

I. General information

NPI: 1093640542
Provider Name (Legal Business Name): CHINAZOM KIZITO ISIOMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

274 LOVELL PL
ERIE PA
16503-2630
US

V. Phone/Fax

Practice location:
  • Phone: 708-265-1524
  • Fax:
Mailing address:
  • Phone: 708-265-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007647
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: