Provider Demographics
NPI:1093895161
Name:PUZZUOLI, THOMAS BRENT (PA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BRENT
Last Name:PUZZUOLI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:6651 HAMBURG RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-5102
Mailing Address - Country:US
Mailing Address - Phone:810-229-6306
Mailing Address - Fax:
Practice Address - Street 1:2215 FULLER RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2335
Practice Address - Country:US
Practice Address - Phone:734-769-7100
Practice Address - Fax:734-769-7099
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601002190363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical