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General NPI Number Information
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NPI Number | 1245220789
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Entity Type | Individual
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Provider Name | MICHAEL LAWRENCE MICHETTI DPM
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Gender | Male
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 702 RUSSELL AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2606
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Country | US
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Telephone | 301-948-3668
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Fax | 301-926-7787
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Provider Business Mailing Address
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Address Line | 702 RUSSELL AVE
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City | GAITHERSBURG
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State | MD
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Zip | 20877-2606
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Country | US
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Telephone | 301-948-3668
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Fax | 301-926-7787
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00270
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License Number State | MD
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