Provider Demographics
NPI:1205868551
Name:PEZZUTO, ANGELA (DPM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:PEZZUTO
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 1:1424 E. 53RD ST., STE.301
Mailing Address - Street 2:MITCHELL FOOT AND ANKLE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615
Mailing Address - Country:US
Mailing Address - Phone:773-324-3338
Mailing Address - Fax:
Practice Address - Street 1:1424 E. 53RD ST., STE.301
Practice Address - Street 2:MITCHELL FOOT AND ANKLE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615
Practice Address - Country:US
Practice Address - Phone:773-324-3338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004902213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU77376Medicare UPIN
IL209685001Medicare PIN
ILK00170Medicare PIN