Provider Demographics
NPI:1003809005
Name:FUGAZZI, JAMES A (MD,)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:FUGAZZI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-5250
Mailing Address - Fax:989-583-5259
Practice Address - Street 1:5400 MACKINAW RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9515
Practice Address - Country:US
Practice Address - Phone:989-583-5250
Practice Address - Fax:989-583-5259
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0861842085R0001X
MIJF0763292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4758357OtherMI MEDICAID-OH LOCATIONS
MI0N24000016OtherMI MEDICARE
MIP00431152OtherRR MEDICARE
MI4758357Medicaid
OH2574003Medicaid
OHP00246120OtherRR MEDICARE
MIP00431152OtherRR MEDICARE
MI4758357Medicaid
OHFU4158962Medicare PIN