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Contact Information

ANZOR MODZGVRESCHVILI, RD
15750 JOY RD
DETROIT, MI48228-2196
 Phone: 313-273-6850
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nutrition, Gerontological

133VN1101X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for ANZOR MODZGVRESCHVILI · (Male)

NPI Number 1245866862
Status Active
Credentials RD (Registered Dietitian)
Entity Individual
Enumeration date 03/15/2020
Last updated 09/20/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • MD License # C05672
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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