Provider Demographics
NPI:1881860906
Name:GALIZIA, TAMMY LOUISE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LOUISE
Last Name:GALIZIA
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:PO BOX 917
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0917
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:847-504-5015
Practice Address - Street 1:40 SKOKIE BLVD STE 520
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1601
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:847-504-5015
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005315213ES0103X
WI959-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005315Medicaid
WI1881860906Medicaid
IL016005315Medicaid
WI810150012Medicare PIN
WIP00724580Medicare PIN
ILP00724577Medicare PIN
WI1881860906Medicaid
ILR03529Medicare PIN
ILR03527Medicare PIN
WI864760023Medicare PIN
WI864810020Medicare PIN
WI850700016Medicare PIN
ILR03529Medicare PIN
WI864860023Medicare PIN
WI864990020Medicare PIN
WI864760023Medicare PIN
ILR03527Medicare PIN
WI864920020Medicare PIN
WI810150012Medicare PIN
WI810150016Medicare PIN
WI864810023Medicare PIN
ILR03530Medicare PIN
WI864860023Medicare PIN
ILR03529Medicare PIN