MEDICARE: ANTONIO DICARLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4351046094	MI

General Provider Information

NPI Number	:	1023631785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO DICARLO

Provider Business Mailing Address
First Line	:	4000 HURON ST
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-8664
Country	:	US
Telephone Number	:	810-688-3048
Fax Number	:	877-848-0921

Provider Business Practice Location Address
First Line	:	4000 HURON ST
Second Line	:
City	:	NORTH BRANCH
State	:	MI
Zip	:	48461-8664
Country	:	US
Telephone Number	:	810-688-3048
Fax Number	:	877-848-0921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2020
Last Update Date	:	11/21/2023

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Directions to “ ANTONIO DICARLO ” Practice Location

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