Provider Demographics
NPI:1275777674
Name:JAMES J. NUZZO DPM SC
Entity Type:Organization
Organization Name:JAMES J. NUZZO DPM SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NUZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-483-5252
Mailing Address - Street 1:1000 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3445
Mailing Address - Country:US
Mailing Address - Phone:847-483-5252
Mailing Address - Fax:847-483-5255
Practice Address - Street 1:1000 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3445
Practice Address - Country:US
Practice Address - Phone:847-483-5252
Practice Address - Fax:847-483-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002553213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36880Medicare UPIN