Provider Demographics
NPI:1043283047
Name:RIZZO, DOMINIC ANGELO (DPM)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:ANGELO
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:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-0322
Mailing Address - Country:US
Mailing Address - Phone:513-474-1906
Mailing Address - Fax:513-474-9272
Practice Address - Street 1:4260 GLENDALE MILFORD RD STE 103
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-3752
Practice Address - Country:US
Practice Address - Phone:513-769-4408
Practice Address - Fax:513-769-4578
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003227R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000256186OtherANTHEM
OH2217925Medicaid
OHP00030052OtherRR MEDICARE
OH4047184Medicare PIN
OH000000256186OtherANTHEM