Healthcare Provider Details

I. General information

NPI: 1760169742
Provider Name (Legal Business Name): MARIA PATZEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 GRAND AVE
NEW HAVEN CT
06513-3733
US

IV. Provider business mailing address

1 GENESYS PKWY STE 4595
GRAND BLANC MI
48439-8065
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax:
Mailing address:
  • Phone: 810-606-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351051798
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83885
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: