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General NPI Number Information
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NPI Number | 1669584132
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Entity Type | Individual
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Provider Name | LOUIS AURELIO FURICCHIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 919 RIVARD BLVD
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City | GROSSE POINTE
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State | MI
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Zip | 48230-1295
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Country | US
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Telephone | 313-821-1815
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Fax | 313-821-1816
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Provider Business Mailing Address
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Address Line | 919 RIVARD BLVD
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City | GROSSE POINTE
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State | MI
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Zip | 48230-1295
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Country | US
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Telephone | 313-821-1815
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Fax | 313-821-1816
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301059867
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License Number State | MI
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