NPIMap

Individual provider Active NPI

Michael S Fozo, MD

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Saint Clair Shores, MI
National Provider Identifier
1114019627
Registry record updated Oct 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
MF075562 Issued in MI
Practice address
21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1116
Phone
(586) 779-7610
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X MF075562 MI Primary

Addresses

Primary practice location

21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1116

Mailing address

21000 E 12 Mile Rd
Ste 111
St Clair Shores, MI 48081
Phone (586) 779-7610

Other identifiers 9

IdentifierTypeStateIssuer
4339229OtherAETNA
H68407OtherHEALTH ALLIANCE PLAN
0501379OtherBLUE CARE NETWORK
4505853MedicaidMI
136815OtherCARE CHOICES
P00014677OtherRAILROAD MEDICARE
141736OtherGREAT LAKES HEALTH PLAN
16056OtherMCAR
6029816OtherCIGNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101214000912 MI Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 4789871971 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Plastic and Reconstructive Surgery
Education
New York Medical College, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17770 Mack Ave
Grosse Pointe, MI 48230-6233
Phone (313) 885-6367

17900 23 Mile Rd
Macomb, MI 48044-1161

21000 E 12 Mile Rd
Suite 111
Saint Clair Shores, MI 48081-1156
Phone (586) 779-7610

22101 Moross Rd
Detroit, MI 48236-2148
Phone (586) 753-0011

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MF075562MIMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital CurrentSince Feb 1, 2012 Accepting new patients
Henry Ford Health St. John Hospital Plastic Surgery Within the Head & Neck CurrentSince Feb 1, 2012 Accepting new patients
Henry Ford Semi Medical Group Current Accepting new patients
Lakeshore Ear Nose and Throat Center PC Current Accepting new patients
Henry Ford Semi Medical Group CurrentSince Sep 4, 2012 Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
St. John Hospital Past Accepting new patients

Locations

43750 Garfield Rd
Ste 101
Clinton Twp, MI 48038
Phone (586) 263-7400

4150 S River Rd
Ste E
East China, MI 48054
Phone (810) 326-2018

22201 Moross Rd
Ste 252
Grosse Pointe, MI 48236
Phone (313) 343-4411

17770 Mack Ave
Grosse Pointe Shores, MI 48230
Phone (313) 882-1731

17900 23 Mile Rd
Ste 203
Macomb, MI 48044
Phone (586) 263-7400

17900 23 Mile Rd
Ste 205
Macomb, MI 48044
Phone (313) 885-6367

21000 E 12 Mile Rd
Ste 111
St Clr Shores, MI 48081
Phone (586) 779-7610

Interoperability endpoints

  • Direct secure messaging: mfozo63536@direct.hfhs.org
  • Direct secure messaging: michael.fozo.1@17789.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191542400000",
    "number": "1114019627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "STE 111",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "48081",
            "telephone_number": "586-779-7610",
            "fax_number": "586-445-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21000 E 12 MILE RD",
            "address_2": "SUITE 111",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480811116",
            "telephone_number": "586-779-7610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOZO",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "MI",
            "license": "MF075562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4339229",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "H68407",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "0501379",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4505853",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "136815",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00014677",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "141736",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCAR",
            "identifier": "16056",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "6029816",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.