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NPI Code Detail

MEDICARE: ANGELA PEZZUTO D.P.M.

MEDICARE:   ANGELA  PEZZUTO  D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0131XFoot Surgery Podiatrist016004902IL

General Provider Information

NPI Number : 1205868551
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA PEZZUTO D.P.M.
Provider Business Mailing Address
First Line : 1424 E. 53RD ST., STE.301
Second Line : MITCHELL FOOT AND ANKLE
City : CHICAGO
State : IL
Zip : 60615
Country : US
Telephone Number : 773-324-3338
Fax Number :
Provider Business Practice Location Address
First Line : 1424 E. 53RD ST., STE.301
Second Line : MITCHELL FOOT AND ANKLE
City : CHICAGO
State : IL
Zip : 60615
Country : US
Telephone Number : 773-324-3338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 04/24/2012

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