Provider Demographics
NPI:1669517314
Name:PRINZO, CAROL J (NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:PRINZO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 CAMPUS RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640
Mailing Address - Country:US
Mailing Address - Phone:989-837-9047
Mailing Address - Fax:989-839-1840
Practice Address - Street 1:4320 CAMPUS RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640
Practice Address - Country:US
Practice Address - Phone:989-837-9047
Practice Address - Fax:989-839-1840
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICP126664207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500G310970OtherBCBS #
MI104289552Medicaid
MI383516078OtherDR'S TAX ID
MI0N51000Medicare ID - Type Unspecified
MIP12104Medicare UPIN