=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386812212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOUIS G IZZO DPM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2008
-----------------------------------------------------
Last Update Date | 05/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 S 8TH ST
-----------------------------------------------------
City | JEANNETTE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15644-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-523-6700
-----------------------------------------------------
Fax | 724-523-2296
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 255 S 8TH ST
-----------------------------------------------------
City | JEANNETTE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15644-3422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-523-6700
-----------------------------------------------------
Fax | 724-523-2296
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF PODIATRIC MEDICINE
-----------------------------------------------------
Name | LOUIS G IZZO
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 724-523-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | SC005609
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------