Provider Demographics
NPI:1588612527
Name:CARROZZA, LEWIS P (DPM)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:P
Last Name:CARROZZA
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 1:4417 147TH ST
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:IL
Mailing Address - Zip Code:60445-2643
Mailing Address - Country:US
Mailing Address - Phone:708-388-3910
Mailing Address - Fax:708-388-3911
Practice Address - Street 1:4417 147TH ST
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:IL
Practice Address - Zip Code:60445-2643
Practice Address - Country:US
Practice Address - Phone:708-388-3910
Practice Address - Fax:708-388-3911
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL16002973213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1128610001OtherDMERC
IL60001033OtherBLUE CROSS BLUE SHIELD
IL1128610001OtherDMERC
IL60001033OtherBLUE CROSS BLUE SHIELD