Healthcare Provider Details

I. General information

NPI: 1720245319
Provider Name (Legal Business Name): MICHAEL MARIO DI IORIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301A DAVIS LN STE 210
AUSTIN TX
78749-3961
US

IV. Provider business mailing address

5301A DAVIS LN STE 210
AUSTIN TX
78749-3961
US

V. Phone/Fax

Practice location:
  • Phone: 512-693-8344
  • Fax:
Mailing address:
  • Phone: 512-693-8344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number49759
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number49759
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number49759
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number49759
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberQ1975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: