Provider Demographics
NPI:1376575597
Name:IANNUZZI, MICHAEL C (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:IANNUZZI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:FIRM C
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-3835
Mailing Address - Fax:315-464-3837
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:FIRM C
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-3835
Practice Address - Fax:315-464-3837
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2010-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY226363207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02361131Medicaid
NYRB8783Medicare PIN