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General NPI Number Information
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NPI Number | 1437607769
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Entity Type | Organization
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Legal Business Name | DENISE J PETENZI, DPM, LLC
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 2644 N WAYNE AVE APT C
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City | CHICAGO
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State | IL
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Zip | 60614-6783
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Country | US
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Telephone | 312-505-0156
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Fax |
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Provider Business Mailing Address
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Address Line | 2644 N WAYNE AVE UNIT C
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City | CHICAGO
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State | IL
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Zip | 60614-1222
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Country | US
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Telephone | 312-505-0156
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Fax | 773-529-3911
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Authorized Official
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Title or Position | OWNER
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Name | DR. DENISE PETENZI
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Credential | DPM
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Telephone | 312-505-0156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016005107
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License Number State | IL
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