Provider Demographics
NPI:1992433361
Name:BLIZZARD, MICHAEL SAMUEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:BLIZZARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 16TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-2538
Mailing Address - Country:US
Mailing Address - Phone:304-437-7992
Mailing Address - Fax:
Practice Address - Street 1:443 16TH ST
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-2538
Practice Address - Country:US
Practice Address - Phone:304-437-7992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant