Provider Demographics
NPI:1114122165
Name:HANDZO, DEREK J (DO)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:J
Last Name:HANDZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:11080 HALL RD STE A
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1511
Mailing Address - Country:US
Mailing Address - Phone:586-254-7200
Mailing Address - Fax:586-254-7201
Practice Address - Street 1:11080 HALL RD STE A
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1511
Practice Address - Country:US
Practice Address - Phone:586-254-7200
Practice Address - Fax:586-254-7201
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017392207YX0905X, 207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery