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General NPI Number Information
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NPI Number | 1346425568
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Entity Type | Organization
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Legal Business Name | MARIO N CORACI PC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 16700 21 MILE RD SUITE 102
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City | MACOMB
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State | MI
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Zip | 48044-4887
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Country | US
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Telephone | 586-263-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 16700 21 MILE RD SUITE 102
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City | MACOMB
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State | MI
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Zip | 48044-4887
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIO CORACI
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Credential | PC
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Telephone | 586-263-8181
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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 | MC0001096
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License Number State | MI
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