Provider Demographics
NPI:1679559918
Name:PIZZO, ANTHONY T (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:T
Last Name:PIZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MANATEE AVENUE WEST
Mailing Address - Street 2:ATT: IPM CREDENTIALING
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8805
Mailing Address - Country:US
Mailing Address - Phone:941-748-2277
Mailing Address - Fax:941-748-8714
Practice Address - Street 1:316 MANATEE AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8805
Practice Address - Country:US
Practice Address - Phone:941-748-2277
Practice Address - Fax:941-748-1958
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055769207RC0000X
FLME55769207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061470000Medicaid
FLP01110052OtherRAILROAD MEDICARE
FL09301VMedicare PIN
LAE42211Medicare UPIN