Healthcare Provider Details

I. General information

NPI: 1396128898
Provider Name (Legal Business Name): DOMINIC FEMMININEO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25311 LITTLE MACK AVE STE B
SAINT CLAIR SHORES MI
48081-3301
US

IV. Provider business mailing address

25311 LITTLE MACK AVE STE B
SAINT CLAIR SHORES MI
48081-3301
US

V. Phone/Fax

Practice location:
  • Phone: 586-498-2400
  • Fax: 586-498-2800
Mailing address:
  • Phone: 586-498-2400
  • Fax: 586-498-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5101021604
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: