Provider Demographics
NPI:1184831521
Name:MICHAEL J FAZIO, MD INC
Entity Type:Organization
Organization Name:MICHAEL J FAZIO, MD INC
Other - Org Name:SKIN CANCER SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-492-1828
Mailing Address - Street 1:2805 J ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4307
Mailing Address - Country:US
Mailing Address - Phone:916-492-1828
Mailing Address - Fax:916-492-1834
Practice Address - Street 1:2805 J ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4307
Practice Address - Country:US
Practice Address - Phone:916-492-1828
Practice Address - Fax:916-492-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25214ZMedicare ID - Type Unspecified