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NPI Code Detail

MEDICARE: DR. DENISE PETENZI DPM

MEDICARE: DR. DENISE PETENZI 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
1213E00000XPodiatrist016-005107IL

General Provider Information

NPI Number : 1457329708
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENISE PETENZI DPM
Provider Business Mailing Address
First Line : 2644 N WAYNE AVE
Second Line : UNIT C
City : CHICAGO
State : IL
Zip : 60614
Country : US
Telephone Number : 312-505-0156
Fax Number : 773-529-3911
Provider Business Practice Location Address
First Line : 3758W CHICAGO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60651-3823
Country : US
Telephone Number : 312-505-0156
Fax Number : 773-529-3911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2006
Last Update Date : 09/02/2015

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