Provider Demographics
NPI:1134143613
Name:NUZZARELLO, JOSEPH (M D)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:NUZZARELLO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E ROOSEVELT RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5574
Mailing Address - Country:US
Mailing Address - Phone:630-653-5550
Mailing Address - Fax:630-653-5561
Practice Address - Street 1:610 E ROOSEVELT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5574
Practice Address - Country:US
Practice Address - Phone:630-653-5550
Practice Address - Fax:630-653-5561
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074164208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E75513Medicare UPIN
K20444Medicare PIN
212210022Medicare PIN