=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760453195
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JOSEPH PALETTA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 MACK AVE
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201-2136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-578-5031
-----------------------------------------------------
Fax | 313-578-6391
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 972 MCDONALD DR
-----------------------------------------------------
City | NORTHVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48167-1071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-578-5031
-----------------------------------------------------
Fax | 313-578-6391
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 047618
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------