Provider Demographics
NPI:1356983795
Name:RIZZO, JOSEPH ALAN (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALAN
Last Name:RIZZO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 PARDEE AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2639
Mailing Address - Country:US
Mailing Address - Phone:313-520-2457
Mailing Address - Fax:
Practice Address - Street 1:1819 E BIG BEAVER RD STE 210
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2015
Practice Address - Country:US
Practice Address - Phone:248-680-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant