Healthcare Provider Details

I. General information

NPI: 1255395745
Provider Name (Legal Business Name): MICHAEL M PASSARETTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 HAYNES ST
MANCHESTER CT
06040-4105
US

IV. Provider business mailing address

36 HAYNES ST
MANCHESTER CT
06040-4105
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-0188
  • Fax: 860-645-9573
Mailing address:
  • Phone: 860-646-0188
  • Fax: 860-645-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number017533
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number017533
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: