DR. MICHAEL S FOZO (NPI# 1114019627) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114019627 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL S FOZO |
| Credential | MD |
| Practice Address |
21000 E 12 Mile Rd Suite 111 Saint Clair Shores MI 48081-1116 |
| Mailing Address |
21000 E 12 Mile Rd Ste 111 St Clair Shores MI 48081 |
| Practice Telephone | 5867797610 |
| Mailing Telephone | 5867797610 |
| Mailing Fax Number | 5864452523 |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2007-10-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
MF075562 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA | 4339229 | 01 | |
| HEALTH ALLIANCE PLAN | H68407 | 01 | |
| MI | 4505853 | 05 | |
| MCAR | 16056 | 01 | |
| CARE CHOICES | 136815 | 01 | |
| GREAT LAKES HEALTH PLAN | 141736 | 01 | |
| RAILROAD MEDICARE | P00014677 | 01 | |
| BLUE CARE NETWORK | 0501379 | 01 | |
| CIGNA | 6029816 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801823471 | Michael L Fozo | Specialist | 22101 Moross Rd, Detroit, MI 48236-2148 | 2006-06-27 |
| Street Address |
21000 E 12 MILE RD SUITE 111 |
| City | SAINT CLAIR SHORES |
| State | MI |
| Zip Code | 48081-1116 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255330486 | Jennifer Kay Appleyard | Allergy & Immunology | 21000 E 12 Mile Rd, Ste 111, Saint Clair Shores, MI 48081-1116 | 2005-07-19 |
| 1881203479 | Andrew Michael Keltz | Speech-Language Pathologist | 21000 E 12 Mile Rd, Saint Clair Shores, MI 48081-1116 | 2020-07-29 |
| 1770120230 | Holly Ann Reckers | Speech-Language Pathologist | 21000 E 12 Mile Rd, Saint Clair Shores, MI 48081-1116 | 2019-12-04 |
| 1578037966 | Maria Juliana Codino | Speech-Language Pathologist | 21000 E 12 Mile Rd, Saint Clair Shores, MI 48081-1116 | 2019-01-18 |
| 1942779921 | Maria D Samsa | Physician Assistant | 21000 E 12 Mile Rd, Saint Clair Shores, MI 48081-1116 | 2018-11-19 |
| 1801331210 | Katja N Tandarich | Nurse Practitioner | 21000 E 12 Mile Rd, Suite 111, Saint Clair Shores, MI 48081-1116 | 2016-12-21 |
| 1053854133 | Jean P. Skeffington | Speech-Language Pathologist | 21000 E 12 Mile Rd, Suite111, Saint Clair Shores, MI 48081-1116 | 2016-11-22 |
| 1134588254 | Alyssa Domenica Baker | Physician Assistant | 21000 E 12 Mile Rd, Saint Clair Shores, MI 48081-1116 | 2016-02-17 |
| 1316350192 | Seton Health Corporation of Southeastern Michigan | Clinic/Center | 21000 E 12 Mile Rd, Suite 105, Saint Clair Shores, MI 48081-1116 | 2014-06-09 |
| 1720404775 | Sean Anthony Cassleman | Internal Medicine | 21000 E 12 Mile Rd, Saint Clair Shores, MI 48081-1116 | 2014-03-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750865416 | Saint Clair Family Pharmacy LLC | Pharmacy | 28001 Harper Ave., Saint Clair Shores, MI 48081 | 2018-09-19 |
| 1669995783 | Terra Laquay Ginther | Social Worker | 28800 Harper Ave Ste A, Saint Clair Shores, MI 48081 | 2017-07-20 |
| 1245676998 | Julia Hanson | Social Worker | 27941 Harper Ave., Suite 105, St. Clair Shores, MI 48081 | 2013-05-21 |
| 1760731301 | Life Transition Service | Community/Behavioral Health | 21031 Sunnydale, St. Clair Shore, MI 48081 | 2012-08-29 |
| 1477868792 | William Burr Wood | Pharmacist | 21000 Twelve Milerd., St Clair Shores, MI 48081 | 2010-08-11 |
| 1508094350 | Dominic Anthony Garrisi | Anesthesiology | 21018 Bon Brae, St. Clair Shores, MI 48081 | 2009-06-30 |
| 1992947022 | Karen Ostrowski-thomas | Occupational Therapist | 22442 Bayview, St. Clair Shores, MI 48081 | 2009-04-06 |
| 1891979787 | Chirag Rachhadia | Physical Therapist | 29150 Harper Avenue, St. Clair Shores, MI 48081 | 2007-12-27 |
| 1598955114 | Donna Warner Manczak | Psychologist | 21400 E Eleven Mil Rd, St Clair Shores, MI 48081 | 2007-07-30 |
| 1467652347 | Sumit Narayanprasad Fogla | Family Medicine | 21400 E Eleven Mile Road, St. Clair Shores, MI 48081 | 2007-07-19 |
| Find all providers in zip 48081 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003903832 | Douglas Carl Kubek | Otolaryngology | 21000 E 12 Mile Rd, Ste 111, Saint Clair Shores, MI 48081-1156 | 2006-10-05 |
| 1982796488 | Amanda J Toole | Otolaryngology | 21000 E 12 Mile Rd, Suite 111, Saint Clair Shores, MI 48081 | 2006-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467853515 | Michigan Ear, Nose, Throat & Allergy Specialist | Otolaryngology | 1445 Sheldon Rd Ste 300, Grand Haven, MI 49417-2479 | 2014-09-09 |
| 1790004166 | Veritas Group LLC | Otolaryngology | 300 S State St Ste 1, Zeeland, MI 49464-1677 | 2010-05-25 |
| 1144354820 | Shoreline Ent Plc | Otolaryngology | 268 Seminole Rd, Muskegon, MI 49444-3733 | 2007-03-15 |
| 1205920873 | Michael Sherbin | Otolaryngology | 309 Northbound Gratiot Ave, Mount Clemens, MI 48043-5748 | 2006-10-03 |
| 1366462350 | Terry R Degroot | Otolaryngology | 1617 Sheldon Rd, Grand Haven, MI 49417-2543 | 2006-07-20 |
| 1740244870 | Richard J Strabbing | Otolaryngology | 3100 N. Wellness Dr, Holland, MI 49424 | 2006-04-14 |
| 1568423986 | Joe S Chomchai | Otolaryngology | 4851 E Pickard St Ste 2700, Mount Pleasant, MI 48858-2042 | 2006-03-28 |
| 1740265362 | Mehmet Cemal Agabigum | Otolaryngology | 5040 Villa Linde Pkwy, Ste A, Flint, MI 48532-3445 | 2005-12-07 |
| 1437519279 | Kathleen Elizabeth Mcclain | Otolaryngology | 15855 19 Mile Rd, Clinton Township, MI 48038-3504 | 2016-03-04 |
| 1285974964 | Drue A Manning | Otolaryngology | 15855 19 Mile Rd, Clinton Township, MI 48038-3504 | 2013-02-18 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLAIR SHORES |
| Zip Code | 48081 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.