Basic Information
| Provider Information | |||||||||
| NPI: | 1386812212 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOUIS G IZZO DPM LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | JEANNETTE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156443422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245236700 | ||||||||
| FaxNumber: | 7245232296 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | JEANNETTE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156443422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245236700 | ||||||||
| FaxNumber: | 7245232296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2008 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| AuthorizedOfficialLastName: | IZZO | ||||||||
| AuthorizedOfficialFirstName: | LOUIS | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR OF PODIATRIC MEDICINE | ||||||||
| AuthorizedOfficialTelephone: | 7245236700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.P.M. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | SC005609 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000145374 | 01 | PA | UNISON | OTHER | 228532 | 01 | PA | COVENTRY HEALTHCARE | OTHER | 0019578490001 | 05 | PA | MEDICAID | 6457419 | 01 | PA | CIGNA | OTHER | 7538456 | 01 | PA | AETNA | OTHER | 321679 | 01 | PA | UPMC | OTHER | P00463385 | 01 | PA | RAILROAD MEDICARE | OTHER | 2015661 | 01 | PA | HIGHMARK BLUE CROSS BLUE SHIELD | OTHER |