Healthcare Provider Details

I. General information

NPI: 1255368429
Provider Name (Legal Business Name): LOUIS G IZZO IV D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 10/03/2020
Certification Date: 10/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S 8TH ST
JEANNETTE PA
15644-3422
US

IV. Provider business mailing address

255 S 8TH ST
JEANNETTE PA
15644-3422
US

V. Phone/Fax

Practice location:
  • Phone: 724-523-6700
  • Fax: 724-523-2296
Mailing address:
  • Phone: 724-523-6700
  • Fax: 724-523-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC005609
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: