Provider Demographics
NPI:1255368429
Name:IZZO, LOUIS G IV (DPM)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:G
Last Name:IZZO
Suffix:IV
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 1:255 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3422
Mailing Address - Country:US
Mailing Address - Phone:724-523-6700
Mailing Address - Fax:724-523-2296
Practice Address - Street 1:255 S 8TH ST
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3422
Practice Address - Country:US
Practice Address - Phone:724-523-6700
Practice Address - Fax:724-523-2296
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005609213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001957849Medicaid
PA227814OtherCOVENTRY HEALTH CARE PLAN
PAP00463385OtherRAILROAD MEDICARE
PA321679OtherUPMC
PA000000145374OtherUNITED HEALTHCARE
PA2015661OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA6457419OtherCIGNA
PA331056384OtherUNITED MINE WORKERS OF AM
7538456OtherAETNA
PA068115Medicare PIN
PA000000145374OtherUNITED HEALTHCARE
PA6457419OtherCIGNA