Basic Information
| Provider Information | |||||||||
| NPI: | 1992719975 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR. LIZA MARIE G. SAVIANO, D.P.M., LTD. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 60 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OSWEGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605438594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305541450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OSWEGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605438594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305541450 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | SAVIANO | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6307078765 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | DF1766 | 01 | IL | RAILROAD MEDICARE | OTHER | 0002232676 | 01 | IL | BLUE CROSS BLUE SHIELD OF IL | OTHER |