Provider Demographics
NPI:1780748319
Name:MAZZARELLA, JOHN D (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:MAZZARELLA
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:3033 OGDEN AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1976
Mailing Address - Country:US
Mailing Address - Phone:630-355-3600
Mailing Address - Fax:630-355-3601
Practice Address - Street 1:3033 OGDEN AVE
Practice Address - Street 2:STE 110
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1976
Practice Address - Country:US
Practice Address - Phone:630-355-3600
Practice Address - Fax:630-355-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL016004364207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery