Provider Demographics
NPI:1942274212
Name:PALAZZOLO, MICHAEL (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PALAZZOLO
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:STE 380
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345
Mailing Address - Country:US
Mailing Address - Phone:818-361-5311
Mailing Address - Fax:818-837-0042
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:STE 380
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345
Practice Address - Country:US
Practice Address - Phone:818-361-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33998207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33998OtherLICENSE
CA00A339980Medicaid
CA00A339980Medicaid
A27327Medicare UPIN