Provider Demographics
NPI:1972520559
Name:PALAZZOLO, MARK R (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:PALAZZOLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 GOLFPARK DR
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4626
Mailing Address - Country:US
Mailing Address - Phone:586-801-8980
Mailing Address - Fax:
Practice Address - Street 1:1160 CYPRESS GLEN CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7560
Practice Address - Country:US
Practice Address - Phone:407-518-1074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10224207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002505OtherPHP
FL281269000Medicaid
FLAS941YOtherMEDICARE
MIP00014737OtherRAILROAD MEDICARE
MI4505156Medicaid
MI200000002505OtherPHP
MI4505156Medicaid