Provider Demographics
NPI:1750364550
Name:KIZY, MICHAEL G (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:KIZY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:29992 NORTHWESTERN HWY STE C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3292
Mailing Address - Country:US
Mailing Address - Phone:248-851-1430
Mailing Address - Fax:248-851-5182
Practice Address - Street 1:32255 NORTHWESTERN HWY STE 180
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-1573
Practice Address - Country:US
Practice Address - Phone:248-355-0880
Practice Address - Fax:248-355-9232
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301057783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1750364550Medicaid
MIMI4989120OtherMEDICARE PTAN