Provider Demographics
NPI:1548276991
Name:MAZZEI, JOSEPH P (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:MAZZEI
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 1:4322 S GARDENIA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-0089
Mailing Address - Country:US
Mailing Address - Phone:312-608-4086
Mailing Address - Fax:
Practice Address - Street 1:4322 S GARDENIA DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-0089
Practice Address - Country:US
Practice Address - Phone:312-608-4086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106115207P00000X
AZ007596207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIMAZZEJOEOtherMERCYCARE INSURANCE
ILP00466577-CD3624OtherRR MEDICARE
IL036106115 8Medicaid
WI1548276991Medicaid
IL036106115 8Medicaid
ILK38051Medicare PIN
ILH77211Medicare UPIN
WI1548276991Medicaid