Provider Demographics
NPI:1215042965
Name:GALLUZZO, PAUL A (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:GALLUZZO
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 1:6999 REDANSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-1201
Mailing Address - Country:US
Mailing Address - Phone:815-229-1008
Mailing Address - Fax:815-229-1654
Practice Address - Street 1:6999 REDANSA DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-1201
Practice Address - Country:US
Practice Address - Phone:815-229-1008
Practice Address - Fax:815-229-1654
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
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
IL602-01257OtherBCBS
IL601-01258OtherBCBS
IL602-01257OtherBCBS
T37973Medicare UPIN
IL601-01258OtherBCBS