Healthcare Provider Details

I. General information

NPI: 1619352176
Provider Name (Legal Business Name): MEGHAN C. LIUZZO NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 W 13 MILE RD SUITE N120A
ROYAL OAK MI
48073-6710
US

IV. Provider business mailing address

130 TOWN CENTER DR SUITE 203
TROY MI
48084-1744
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-7370
  • Fax: 248-551-7373
Mailing address:
  • Phone: 248-585-8265
  • Fax: 248-585-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704242869
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704242869
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: