Healthcare Provider Details

I. General information

NPI: 1679559918
Provider Name (Legal Business Name): ANTHONY T PIZZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MANATEE AVE W
BRADENTON FL
34205-8805
US

IV. Provider business mailing address

316 MANATEE AVENUE WEST ATT: IPM CREDENTIALING
BRADENTON FL
34205-8805
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2277
  • Fax: 941-748-1958
Mailing address:
  • Phone: 941-748-2277
  • Fax: 941-748-8714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0055769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME55769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: