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General NPI Number Information
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NPI Number | 1295828358
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Entity Type | Individual
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Provider Name | ANDREW I. DZUL M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 21000 E 12 MILE RD SUITE 111
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-1116
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Country | US
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Telephone | 586-779-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 21000 E 12 MILE RD STE 111
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City | ST CLAIR SHORES
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State | MI
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Zip | 48081
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Country | US
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Telephone | 586-779-7610
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Fax | 586-445-2523
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0602X
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Taxonomy Name | Otolaryngic Allergy Physician
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License Number | AD044645
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License Number State | MI
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