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General NPI Number Information
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NPI Number | 1922145945
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Entity Type | Individual
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Provider Name | RONALD EDWARD IZYNSKI I DPM
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 2501 VALLEY DR
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City | VALPARAISO
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State | IN
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Zip | 46383-2518
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Country | US
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Telephone | 221-992-1144
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Fax | 219-921-5303
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Provider Business Mailing Address
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Address Line | 601 GATEWAY BLVD N
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City | CHESTERTON
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State | IN
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Zip | 46304-9658
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Country | US
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Telephone | 219-921-1444
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Fax | 219-921-5303
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 07000499A
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License Number State | IN
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