Basic Information
Provider Information
NPI: 1033558283
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIZZO
FirstName: ANTHONY
MiddleName: FRANCIS
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7447 W TALCOTT AVE
Address2: STE 182
City: CHICAGO
State: IL
PostalCode: 606313712
CountryCode: US
TelephoneNumber: 7737925155
FaxNumber:  
Practice Location
Address1: 7447 W TALCOTT AVE
Address2: STE. 182
City: CHICAGO
State: IL
PostalCode: 606313745
CountryCode: US
TelephoneNumber: 7739907648
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/20/2013
LastUpdateDate: 02/09/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X125.063025ILY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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