Provider Demographics
NPI:1568275659
Name:CAPIZZI, MARCO ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTHONY
Last Name:CAPIZZI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13224 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2076
Mailing Address - Country:US
Mailing Address - Phone:586-554-0360
Mailing Address - Fax:
Practice Address - Street 1:48801 ROMEO PLANK RD
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-2165
Practice Address - Country:US
Practice Address - Phone:586-726-4823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant