Provider Demographics
NPI:1023220605
Name:CYZIO, MARTA (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:CYZIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 TIPPERARY DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6030
Mailing Address - Country:US
Mailing Address - Phone:321-213-5625
Mailing Address - Fax:
Practice Address - Street 1:1368 TIPPERARY DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6030
Practice Address - Country:US
Practice Address - Phone:321-213-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7123971OtherAETNA PPO
FL90301OtherBLUE CROSS BLUE SHIELD
FL7123971OtherAETNA
FL390919OtherWELLCRE
FL278372000Medicaid
FL278372000Medicaid