Individual
MRS. LENNI FUGAZY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1611 W HARRISON ST # 400, CHICAGO, IL 60612-4861
(312) 243-4244
(312) 942-1517
Mailing address
1041 WYOMI DR, FORT MYERS, FL 33919-2635
(239) 321-9055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9104242
FL
363AS0400X
Surgical Physician Assistant
Primary
085002149
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1633878
BCBS PPO
IL
05
—
292866300
—
FL
01
—
P00990032
RR MEDICARE
IL
Enumeration date
05/23/2006
Last updated
01/12/2021
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