Provider Demographics
NPI:1053326801
Name:CAROLE B. RIZZO, D.O. PLLC
Entity Type:Organization
Organization Name:CAROLE B. RIZZO, D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-338-8900
Mailing Address - Street 1:1750 S. TELEGRAPH
Mailing Address - Street 2:STE 104
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0179
Mailing Address - Country:US
Mailing Address - Phone:248-338-8900
Mailing Address - Fax:248-338-8934
Practice Address - Street 1:1750 S. TELEGRAPH
Practice Address - Street 2:STE 104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0179
Practice Address - Country:US
Practice Address - Phone:248-338-8900
Practice Address - Fax:248-338-8934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICR007781207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB44755Medicare UPIN
MI0N25150Medicare ID - Type Unspecified