Provider Demographics
NPI:1669134193
Name:MIOZZI, MICHAEL THOMAS (IDHS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:MIOZZI
Suffix:
Gender:M
Credentials:IDHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCGC HARRIET LANE ATTN: HS1 MIOZZI
Mailing Address - Street 2:4000 COAST GUARD BLVD
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-274-5503
Mailing Address - Fax:
Practice Address - Street 1:BASE PORTSMOUTH PORTSMOUTH
Practice Address - Street 2:4000 COAST GUARD BLVD
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-483-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman