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General NPI Number Information
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NPI Number | 1720160252
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Entity Type | Individual
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Provider Name | MATTHEW JAMES DIMAGNO MD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 1650 RAMBLEWOOD DR STE 100
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City | EAST LANSING
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State | MI
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Zip | 48823-7396
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Country | US
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Telephone | 517-332-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 5054 GULLANE DR
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City | ANN ARBOR
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State | MI
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Zip | 48103-9750
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Country | US
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Telephone | 734-678-5758
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Fax |
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301065725
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License Number State | MI
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