Provider Demographics
NPI:1255735254
Name:DZIAT, MICHAEL (AGNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DZIAT
Suffix:
Gender:M
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAKESIDE AVE E
Mailing Address - Street 2:STE 1000
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1158
Mailing Address - Country:US
Mailing Address - Phone:440-258-6072
Mailing Address - Fax:216-420-9354
Practice Address - Street 1:1001 LAKESIDE AVE E
Practice Address - Street 2:STE 1000
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-1158
Practice Address - Country:US
Practice Address - Phone:440-258-6072
Practice Address - Fax:216-420-9354
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH16445363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner