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NPI Code Detail

MEDICARE: CAYETANO PUZON DPM

MEDICARE: CAYETANO PUZON DPM
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
1213EP1101XPrimary Podiatric Medicine Podiatrist016004484IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265651905
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAYETANO PUZON DPM
Provider Business Mailing Address
First Line : 2 E OAK ST APT 3601
Second Line :
City : CHICAGO
State : IL
Zip : 60611-6203
Country : US
Telephone Number : 312-642-2236
Fax Number : 312-642-2236
Provider Business Practice Location Address
First Line : 5310 N SHERIDAN RD
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2514
Country : US
Telephone Number : 773-769-8165
Fax Number : 773-769-8167
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2007
Last Update Date : 07/08/2007

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Directions to “ CAYETANO PUZON DPM” Practice Location

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