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General NPI Number Information
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NPI Number | 1417007428
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Entity Type | Individual
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Provider Name | IVANA MARIA VETTRAINO M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 1 HURLEY PLZ # 9W
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City | FLINT
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State | MI
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Zip | 48503-5902
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Country | US
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Telephone | 810-262-4787
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Fax | 810-262-9243
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Provider Business Mailing Address
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Address Line | 1 HURLEY PLZ ATTN PROFESSIONAL BILLING DEPT
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City | FLINT
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State | MI
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Zip | 48503-5902
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Country | US
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Telephone | 810-262-9002
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Fax | 810-262-7317
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301062868
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 73409-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 4301062868
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | M-13596
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | 100075
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License Number State | MO
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