Provider Demographics
NPI:1962672279
Name:LOUIS G. IZZO IV
Entity Type:Organization
Organization Name:LOUIS G. IZZO IV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:IV
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-523-6700
Mailing Address - Street 1:826 LOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-2661
Mailing Address - Country:US
Mailing Address - Phone:724-523-6700
Mailing Address - Fax:724-523-2296
Practice Address - Street 1:826 LOWRY AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-2661
Practice Address - Country:US
Practice Address - Phone:724-523-6700
Practice Address - Fax:724-523-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005609213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5001560001Medicare NSC