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
1	213ES0131X	Foot Surgery Podiatrist	016004902	IL

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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