Healthcare Provider Details

I. General information

NPI: 1477583946
Provider Name (Legal Business Name): MARY ELIZABETH PIETRANGELO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 OAKWOOD LN
SAINT CLAIR MI
48079-5286
US

IV. Provider business mailing address

1160 OAKWOOD LN
SAINT CLAIR MI
48079-5286
US

V. Phone/Fax

Practice location:
  • Phone: 313-720-3684
  • Fax:
Mailing address:
  • Phone: 313-720-3684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301066082
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number4301066082
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: