Healthcare Provider Details

I. General information

NPI: 1467577239
Provider Name (Legal Business Name): JOANNA M POLIZZI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8000
  • Fax: 616-840-9642
Mailing address:
  • Phone: 616-840-8000
  • Fax: 616-840-9642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003649
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: