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General NPI Number Information
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NPI Number | 1982067096
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Entity Type | Individual
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Provider Name | VINCENT DEMATIO
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Gender | Male
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 2525 7TH AVE S
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City | ESCANABA
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State | MI
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Zip | 49829-1131
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Country | US
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Telephone | 248-860-4634
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Fax |
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Provider Business Mailing Address
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Address Line | 4954 STILLWAGON RD
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City | WEST BRANCH
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State | MI
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Zip | 48661-9662
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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 |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35.134465
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301118997
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License Number State | MI
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