Provider Demographics
NPI:1770500332
Name:BIZZIGOTTI, PAUL REMO (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:REMO
Last Name:BIZZIGOTTI
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 1:8872 PROFESSIONAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8482
Mailing Address - Country:US
Mailing Address - Phone:231-779-0320
Mailing Address - Fax:231-779-1367
Practice Address - Street 1:8872 PROFESSIONAL DR STE B
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8482
Practice Address - Country:US
Practice Address - Phone:231-779-0320
Practice Address - Fax:231-779-1367
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057805207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4228065Medicaid
MIPB057805OtherBCBS ID NUMBER
MI200H310170OtherBCBS GROUP ID NUMBER
ON13960001Medicare ID - Type UnspecifiedGROUP ID NUMBER
MI4228065Medicaid