Healthcare Provider Details

I. General information

NPI: 1386822369
Provider Name (Legal Business Name): MICHAEL E ESTATICO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BOWER HILL RD
PITTSBURGH PA
15243-1873
US

IV. Provider business mailing address

14 WHITE BIRCH CIR
PITTSBURGH PA
15220-2040
US

V. Phone/Fax

Practice location:
  • Phone: 800-394-4445
  • Fax: 706-650-1034
Mailing address:
  • Phone: 412-276-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN502614L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: