Healthcare Provider Details

I. General information

NPI: 1457451049
Provider Name (Legal Business Name): DAVID A PICONE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 PATIENT CARE WAY SUITE 101
LANSING MI
48911-4275
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-882-3738
  • Fax: 517-882-3633
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101009902
License Number StateMI

VIII. Authorized Official

Name: DAVID A PICONE
Title or Position: OWNER
Credential: DO
Phone: 517-882-3732