Individual
ANGELO ILLUZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
621 S MAIN ST, DU BOIS, PA 15801-1413
(814) 503-8573
(814) 503-8574
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 503-8573
(814) 503-8574
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
0S008438L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014671870004
—
PA
01
—
104291
UPMC
PA
01
—
13489
GEISINGER
PA
01
—
610283400
BLACK LUNG
—
01
—
740698
BLUE SHIELD
PA
01
—
P00233037
METRAHEALTH RAILROAD MEDI
—
Enumeration date
08/30/2006
Last updated
06/21/2016
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