Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 5101017392 | MI |
NPI | 1114122165 |
---|---|
Provider Name | Dr. Derek J Handzo |
First Address | Sterling Heights, MI 48314-1511 |
Second Address | Sterling Heights, MI 48314-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 09/11/2019 |