Provider Demographics
NPI:1417478017
Name:ALENZI MD PC
Entity Type:Organization
Organization Name:ALENZI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUTIMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-525-4252
Mailing Address - Street 1:21919 HICKORYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2484
Mailing Address - Country:US
Mailing Address - Phone:313-730-9260
Mailing Address - Fax:248-957-6970
Practice Address - Street 1:24331 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1129
Practice Address - Country:US
Practice Address - Phone:313-730-9260
Practice Address - Fax:248-957-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty