Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 016004902 | IL |
NPI | 1205868551 |
---|---|
Provider Name | Angela Pezzuto |
First Address | Chicago, IL 60615 |
Second Address | Chicago, IL 60615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 24/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U77376 | (02) | IL |