MEDICARE: DR. ANTHONY P SALVAGIONE M.D.

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	207R00000X	Internal Medicine Physician	4301033644	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	76-30043	OTHER	MI	PHYSICIANS HEALTH PLAN

General Provider Information

NPI Number	:	1124024260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY P SALVAGIONE M.D.

Provider Business Mailing Address
First Line	:	3380 LINCOLN AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3703
Country	:	US
Telephone Number	:	269-985-0029
Fax Number	:	269-985-0040

Provider Business Practice Location Address
First Line	:	820 LESTER AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2561
Country	:	US
Telephone Number	:	269-985-0029
Fax Number	:	269-985-0040

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/25/2007

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