Provider Demographics
NPI:1194708271
Name:RIZZO, THOMAS J (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:RIZZO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1236
Mailing Address - Country:US
Mailing Address - Phone:309-944-5546
Mailing Address - Fax:309-944-8267
Practice Address - Street 1:241 N STATE ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1236
Practice Address - Country:US
Practice Address - Phone:309-944-5546
Practice Address - Fax:309-944-8267
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU67942Medicare UPIN
K13632Medicare ID - Type Unspecified
IL5319270001Medicare NSC