=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093018814
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL PIZINSKI MED, BS IN HEALTH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2010
-----------------------------------------------------
Last Update Date | 05/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5916 SW MORGAN DR
-----------------------------------------------------
City | GUTHRIE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73044-6731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-369-9149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5916 SW MORGAN DR
-----------------------------------------------------
City | GUTHRIE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73044-6731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 228-369-9149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------