Active NPI
Edward Pazuchowski, M.D.
- Family Medicine Physician
- Roseville, MI
National Provider Identifier
1710979638
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301047752
- Practice address
- 29751 Little Mack Ave
Roseville, MI 48066-6503 - Phone
- (586) 447-4100
- Fax
- (586) 447-4117
- NPI assigned
- Aug 17, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301047752 | MI | Primary |
Addresses
Primary practice location
29751 Little Mack Ave
Roseville, MI 48066-6503
Mailing address
P.O. Box 77000
Department 771036
Detroit, MI 48277-1036
Phone (586) 447-4171
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3024768 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297728000000",
"number": "1710979638",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 77000",
"address_2": "DEPARTMENT 771036",
"city": "DETROIT",
"state": "MI",
"postal_code": "482771036",
"telephone_number": "586-447-4171",
"fax_number": "586-447-4180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29751 LITTLE MACK AVE",
"city": "ROSEVILLE",
"state": "MI",
"postal_code": "480666503",
"telephone_number": "586-447-4100",
"fax_number": "586-447-4117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAZUCHOWSKI",
"first_name": "EDWARD",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-17",
"last_updated": "2011-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301047752",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3024768",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roseville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.