Healthcare Provider Details

I. General information

NPI: 1720168610
Provider Name (Legal Business Name): MICHAEL A DIPIETRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. MEDICAL CENTER DR, 3RD FLOOR RECP. A ROOM 3660A C.S. MOTT CHILDREN'S HOSPITAL
ANN ARBOR MI
48109-4252
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4500
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301044848
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number4301044848
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301044848
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: