Provider Demographics
NPI:1881764579
Name:LUZZI, CAROL D (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:D
Last Name:LUZZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:SUITE 5550
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1156
Practice Address - Country:US
Practice Address - Phone:574-647-2550
Practice Address - Fax:574-647-2549
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01064266A208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200116740Medicaid
IN000000736261OtherBCBS MEMORIAL CHILDRENS
IN200116740Medicaid
IN200116740Medicaid
IN259900002Medicare PIN