Provider Demographics
NPI:1619243995
Name:JOSEPH J. PREZZATO M.D., PLLC
Entity Type:Organization
Organization Name:JOSEPH J. PREZZATO M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARRAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:PREZZATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-320-6221
Mailing Address - Street 1:30445 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3158
Mailing Address - Country:US
Mailing Address - Phone:248-855-2229
Mailing Address - Fax:
Practice Address - Street 1:30445 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3158
Practice Address - Country:US
Practice Address - Phone:248-855-2229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088750207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1619243995Medicare Oscar/Certification