Provider Demographics
NPI:1417121757
Name:MARCO RIZZO MD INC
Entity Type:Organization
Organization Name:MARCO RIZZO MD INC
Other - Org Name:THE PLASTIC SURGERY CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-533-2900
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-533-2900
Mailing Address - Fax:808-531-8991
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 401
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-533-2900
Practice Address - Fax:808-531-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2392208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HMRIZZOOtherINDIVIDUAL MEDICARE PIN
HMRIZZOOtherINDIVIDUAL MEDICARE PIN
D43616Medicare UPIN