MEDICARE: DR. MATTEO C LOPICCOLO MD

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
1	207ND0101X	MOHS-Micrographic Surgery Physician	4301092937	MI

General Provider Information

NPI Number	:	1952565897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTEO C LOPICCOLO MD

Provider Business Mailing Address
First Line	:	43151 DALCOMA DR STE 4
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-6306
Country	:	US
Telephone Number	:	586-286-8720
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 N CANTON CENTER RD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-5096
Country	:	US
Telephone Number	:	734-495-1506
Fax Number	:	734-495-1780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	05/31/2024

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