Provider Demographics
NPI:1265583587
Name:NUZZO, MICHAEL SALVATORE (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SALVATORE
Last Name:NUZZO
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 1:340 DARDANELLI LN STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1418
Mailing Address - Country:US
Mailing Address - Phone:408-412-8110
Mailing Address - Fax:408-412-8499
Practice Address - Street 1:4140 JADE ST STE 100
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3940
Practice Address - Country:US
Practice Address - Phone:831-475-4024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23242207X00000X
KYTP995207X00000X
AZ75147207X00000X
CAA119628207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00533064OtherMEDICARE KY- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY50021615OtherPASSPORT- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY200931250OtherHEALTHY INDIANA PLAN- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
IN200931250OtherMEDICAID INDIANA- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY200931250OtherANTHEM INDIANA MEDICAID- CHILDREN'S ORTHOPAEDICS OF LOUISVILLE
KY7100097170Medicaid