Provider Demographics
NPI:1629206792
Name:LEWIS P CARROZZA DPM PC
Entity Type:Organization
Organization Name:LEWIS P CARROZZA DPM PC
Other - Org Name:LEWIS P CARROZZA DPM PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARROZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:708-388-3910
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL957200Medicare PIN
IL1128610001Medicare NSC