Healthcare Provider Details

I. General information

NPI: 1821185224
Provider Name (Legal Business Name): MICHAEL DIGIACOMO DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 30TH ST
OAKLAND CA
94609-3337
US

IV. Provider business mailing address

445 30TH ST
OAKLAND CA
94609-3337
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-8012
  • Fax: 510-835-1626
Mailing address:
  • Phone: 510-465-8012
  • Fax: 510-835-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1909
License Number StateCA

VIII. Authorized Official

Name: MICHAEL ARTHUR DIGIACOMO
Title or Position: OWNER
Credential: D.P.M.
Phone: 510-465-8012