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General NPI Number Information
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NPI Number | 1720152846
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Entity Type | Individual
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Provider Name | TIMOTHY J IZZO DO
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 1035 CHARLEVOIX DR SUITE 100
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City | GRAND LEDGE
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State | MI
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Zip | 48837-2223
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Country | US
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Telephone | 517-627-2181
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Fax | 517-622-1242
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Provider Business Mailing Address
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Address Line | 1035 CHARLEVOIX DR SUITE 100
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City | GRAND LEDGE
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State | MI
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Zip | 48837-2223
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Country | US
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Telephone | 517-627-2181
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Fax | 517-622-1242
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | TI011387
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License Number State | MI
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