Provider Demographics
NPI:1285061283
Name:YSUNZA, PABLO - ANTONIO (M D, PH D)
Entity type:Individual
Prefix:DR
First Name:PABLO - ANTONIO
Middle Name:
Last Name:YSUNZA
Suffix:
Gender:M
Credentials:M D, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 LONGFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4814
Mailing Address - Country:US
Mailing Address - Phone:248-551-2100
Mailing Address - Fax:248-551-4692
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:248-551-2100
Practice Address - Fax:248-551-4692
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104204282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital