Healthcare Provider Details

I. General information

NPI: 1760453195
Provider Name (Legal Business Name): MICHAEL JOSEPH PALETTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MACK AVE
DETROIT MI
48201-2136
US

IV. Provider business mailing address

972 MCDONALD DR
NORTHVILLE MI
48167-1071
US

V. Phone/Fax

Practice location:
  • Phone: 313-578-5031
  • Fax: 313-578-6391
Mailing address:
  • Phone: 313-578-5031
  • Fax: 313-578-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number047618
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: