Provider Demographics
NPI:1679703839
Name:EIZANS, VITA RANDAZZO (DO)
Entity type:Individual
Prefix:DR
First Name:VITA
Middle Name:RANDAZZO
Last Name:EIZANS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:VITA
Other - Middle Name:ELISABETH
Other - Last Name:RANDAZZO-EIZANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6245 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4001
Mailing Address - Country:US
Mailing Address - Phone:734-458-4486
Mailing Address - Fax:
Practice Address - Street 1:6245 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4001
Practice Address - Country:US
Practice Address - Phone:734-458-4486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018180207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology