Provider Demographics
NPI:1295828358
Name:DZUL, ANDREW I (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:I
Last Name:DZUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21000 E 12 MILE RD
Mailing Address - Street 2:STE 111
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081
Mailing Address - Country:US
Mailing Address - Phone:586-779-7610
Mailing Address - Fax:586-445-2523
Practice Address - Street 1:21000 E 12 MILE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1116
Practice Address - Country:US
Practice Address - Phone:586-779-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAD044645207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
101664OtherCARE CHOICES
MI040E061920OtherBLUE SHIELD GROUP
C4865OtherMCARE
MI0405001172OtherBLUE CROSS BLUE SHIELD
0500117OtherBLUE CARE NETWORK
103904OtherGREAT LAKES
040000850OtherRAILROAD MEDICARE
2340163001OtherCIGNA
4033205OtherAETNA
A76344OtherHEALTH ALLIANCE PLAN
MI05001177041Medicare ID - Type Unspecified
A76344OtherHEALTH ALLIANCE PLAN
MI0E06192005Medicare ID - Type UnspecifiedMEDICARE GROUP