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NPI Code Detail

MEDICARE: MRS. MICHELLE LOUISE DELOSSANTOS MSATC

MEDICARE: MRS. MICHELLE LOUISE DELOSSANTOS MSATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1790998839
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LOUISE DELOSSANTOS MSATC
Provider Business Mailing Address
First Line : 130 CAMELOT DR
Second Line : APT. A10
City : SAGINAW
State : MI
Zip : 48638-6457
Country : US
Telephone Number : 989-245-6056
Fax Number :
Provider Business Practice Location Address
First Line : 3901 BAY RD
Second Line :
City : SAGINAW
State : MI
Zip : 48603-2438
Country : US
Telephone Number : 989-797-6040
Fax Number : 989-797-6054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 07/08/2007

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