Healthcare Provider Details

I. General information

NPI: 1669134193
Provider Name (Legal Business Name): MICHAEL THOMAS MIOZZI IDHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BASE PORTSMOUTH PORTSMOUTH 4000 COAST GUARD BLVD
PORTSMOUTH VA
23435
US

IV. Provider business mailing address

USCGC HARRIET LANE ATTN: HS1 MIOZZI 4000 COAST GUARD BLVD
PORTSMOUTH VA
23435
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-8596
  • Fax:
Mailing address:
  • Phone: 757-274-5503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: