Healthcare Provider Details

I. General information

NPI: 1417971375
Provider Name (Legal Business Name): DAVID BRYAN PINELLI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N ORTONVILLE RD
ORTONVILLE MI
48462-8575
US

IV. Provider business mailing address

50 N PERRY ST
PONTIAC MI
48342-2217
US

V. Phone/Fax

Practice location:
  • Phone: 248-627-3535
  • Fax: 248-627-9134
Mailing address:
  • Phone: 248-338-5516
  • Fax: 248-338-5547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101012677
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: