Provider Demographics
NPI:1477579878
Name:PLIZGA, MARC ADAM (ATC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ADAM
Last Name:PLIZGA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6173 TYLER WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-1972
Mailing Address - Country:US
Mailing Address - Phone:248-625-5998
Mailing Address - Fax:248-625-3975
Practice Address - Street 1:6770 DIXIE HWY
Practice Address - Street 2:SUITE 104
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2087
Practice Address - Country:US
Practice Address - Phone:248-625-5998
Practice Address - Fax:248-625-3975
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer