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Individual
TIMOTHY J IZZO
Active
Individual
TIMOTHY J IZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TI011387
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080079681
MEDICARE RAILROAD
—
01
—
0852328574
BCBS INDIVIDUAL PIN
MI
01
—
P85301
BCN PIN NUMBER
MI
Enumeration date
11/20/2006
Last updated
01/30/2014
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