MEDICARE: DR. MICHAEL DI MARTINO PSY.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	103TC0700X	Clinical Psychologist	6301019776	MI

General Provider Information

NPI Number	:	1316505969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DI MARTINO PSY.D.

Provider Business Mailing Address
First Line	:	4053 OLD 31 S
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-9691
Country	:	US
Telephone Number	:	650-387-3927
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 BRIDGE ST
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-1400
Country	:	US
Telephone Number	:	650-387-3927
Fax Number	:

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

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	12/19/2025

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