Provider Demographics
NPI:1457329708
Name:PETENZI, DENISE (DPM)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:
Last Name:PETENZI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2644 N WAYNE AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:312-505-0156
Mailing Address - Fax:773-529-3911
Practice Address - Street 1:3758W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-3823
Practice Address - Country:US
Practice Address - Phone:312-505-0156
Practice Address - Fax:773-529-3911
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005107213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU98422Medicare UPIN