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General NPI Number Information
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NPI Number | 1962672279
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Entity Type | Organization
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Legal Business Name | LOUIS G. IZZO IV
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 826 LOWRY AVE
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City | JEANNETTE
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State | PA
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Zip | 15644-2661
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Country | US
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Telephone | 724-523-6700
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Fax | 724-523-2296
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Provider Business Mailing Address
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Address Line | 826 LOWRY AVE
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City | JEANNETTE
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State | PA
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Zip | 15644-2661
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Country | US
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Telephone | 724-523-6700
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Fax | 724-523-2296
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Authorized Official
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Title or Position | PODIATRIST
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Name | LOUIS G IZZO IV
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Credential | D.P.M.
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Telephone | 724-523-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | SC005609
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License Number State | PA
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