| Doctor Name: | DR. MICHAEL JOSEPH EZZO |
| NPI Number: | 1760651913 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.D. |
| License Number: | 6301005670 |
| Business Practice Address: | 3960 Patient Care Way Suite 1017 Lansing, MI - 489114275 |
| Business Phone Number: | 5173944715 |
| Business Fax Number: | 5173941423 |
| Mailing Address: | 3960 Patient Care Way, Suite 117 LANSING |
| State: | MI |
| Postal Code: | 489114275 |
| Phone Number: | 5173944715 |
| Fax Number: | 5173941423 |
| NPI Enumeration Date: | 02/21/2008 |
| NPI Last Update Date: | 10/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | 6301005670 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |