Provider Demographics
NPI:1538115357
Name:POLIZZI, JOSEPH (DO, FAAFP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:POLIZZI
Suffix:
Gender:M
Credentials:DO, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 RAYBROOK ST SE STE 100B
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7759
Mailing Address - Country:US
Mailing Address - Phone:616-320-0096
Mailing Address - Fax:616-320-0097
Practice Address - Street 1:2100 RAYBROOK ST SE STE 100B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7759
Practice Address - Country:US
Practice Address - Phone:616-320-0096
Practice Address - Fax:616-320-0097
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4591664Medicaid
MI4100022Medicaid
MI4148330Medicaid
MI4202318Medicaid
MI4876931Medicaid
MI4168495Medicaid
MI4168495Medicaid
MI4148330Medicaid
MI4876931Medicaid
MIP32930124Medicare ID - Type Unspecified