Provider Demographics
NPI:1134388143
Name:PEZZI, KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PEZZI
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 1:6680 TRAVERSE RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49683-9008
Mailing Address - Country:US
Mailing Address - Phone:231-269-4473
Mailing Address - Fax:
Practice Address - Street 1:6680 TRAVERSE RD
Practice Address - Street 2:
Practice Address - City:THOMPSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49683-9008
Practice Address - Country:US
Practice Address - Phone:231-269-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407443208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice