Individual
ANZOR MODZGVRESCHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
15750 JOY RD, DETROIT, MI 48228-2196
(313) 273-6850
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
Taxonomy
Speciality
Code
Description
License number
State
133VN1101X
Gerontological Nutrition Registered Dietitian
Primary
C05672
MD
133VN1101X
Gerontological Nutrition Registered Dietitian
—
—
Other
Enumeration date
03/15/2020
Last updated
09/20/2022
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