Provider Demographics
NPI:1891747820
Name:RIZZO, CAROLE B (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:B
Last Name:RIZZO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1750 S TELEGRAPH RD
Mailing Address - Street 2:104
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0166
Mailing Address - Country:US
Mailing Address - Phone:248-338-8900
Mailing Address - Fax:248-338-8934
Practice Address - Street 1:1750 S TELEGRAPH RD
Practice Address - Street 2:104
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0166
Practice Address - Country:US
Practice Address - Phone:248-338-8900
Practice Address - Fax:248-338-8934
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICR007781207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1634605Medicaid
MI0N25150Medicare ID - Type Unspecified
MI1634605Medicaid