Provider Demographics
NPI:1811137102
Name:LANZITO, ALICIA M (DPM, SA-C)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:M
Last Name:LANZITO
Suffix:
Gender:F
Credentials:DPM, SA-C
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:MARTIN
Other - Last Name:LANZITO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM, SA-C
Mailing Address - Street 1:1550 HOBBS DR
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2027
Mailing Address - Country:US
Mailing Address - Phone:262-740-4200
Mailing Address - Fax:
Practice Address - Street 1:1550 HOBBS DR
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115
Practice Address - Country:US
Practice Address - Phone:262-740-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005394213ES0103X
WI1040213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100035381Medicaid