Healthcare Provider Details

I. General information

NPI: 1669295101
Provider Name (Legal Business Name): ALEXANDRIA MARIE PALAZZOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29200 NORTHWESTERN HWY STE 110
SOUTHFIELD MI
48034-1055
US

IV. Provider business mailing address

905 N STEPHENSON HWY APT 29
ROYAL OAK MI
48067-2157
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number2013468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: