Provider Demographics
NPI:1912073222
Name:BRUZZO, MICHELLE Y (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:Y
Last Name:BRUZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 CLINT MOORE ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:561-477-4910
Mailing Address - Fax:561-988-5348
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2658
Practice Address - Country:US
Practice Address - Phone:561-477-4910
Practice Address - Fax:561-988-5348
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46567YMedicare PIN
FLG99644Medicare UPIN