MEDICARE: PAUL MILITELLO LLP

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	6301010133	MI

General Provider Information

NPI Number	:	1609914647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MILITELLO LLP

Provider Business Mailing Address
First Line	:	16499 LYNETTE DR
Second Line	:
City	:	MACOMB
State	:	MI
Zip	:	48042-5813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21885 DUNHAM RD
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48036-1030
Country	:	US
Telephone Number	:	586-469-5950
Fax Number	:

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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Directions to “ PAUL MILITELLO LLP” Practice Location

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