Provider Demographics
NPI:1558623744
Name:RIZZO, JOSEPH V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:V
Last Name:RIZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:JEANETTE
Other - Middle Name:THOMAS
Other - Last Name:RIZZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:58520 CORY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-4206
Mailing Address - Country:US
Mailing Address - Phone:586-677-5268
Mailing Address - Fax:
Practice Address - Street 1:58520 CORY LAKE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-4206
Practice Address - Country:US
Practice Address - Phone:586-677-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI025321208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMRA76092Medicare PIN