Provider Demographics
NPI:1265651905
Name:PUZON, CAYETANO (DPM)
Entity Type:Individual
Prefix:
First Name:CAYETANO
Middle Name:
Last Name:PUZON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E OAK ST APT 3601
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6203
Mailing Address - Country:US
Mailing Address - Phone:312-642-2236
Mailing Address - Fax:312-642-2236
Practice Address - Street 1:5310 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2514
Practice Address - Country:US
Practice Address - Phone:773-769-8165
Practice Address - Fax:773-769-8167
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004484213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004484Medicaid
IL016004484Medicaid
IL937310Medicare ID - Type Unspecified