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NPI Code Detail

MEDICARE: PHILIP STANLEY VENDITTELLI D.O.

MEDICARE: PHILIP STANLEY VENDITTELLI D.O.
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
1207R00000XInternal Medicine Physician5101022293MI
2207RC0000XCardiovascular Disease Physician51024546MI
3207RI0011XInterventional Cardiology Physician5315204612MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871949925
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP STANLEY VENDITTELLI D.O.
Provider Business Mailing Address
First Line : 22101 MOROSS RD FL 2
Second Line :
City : DETROIT
State : MI
Zip : 48236-2148
Country : US
Telephone Number : 313-343-4612
Fax Number :
Provider Business Practice Location Address
First Line : 18303 E 10 MILE RD STE 100
Second Line :
City : ROSEVILLE
State : MI
Zip : 48066-4989
Country : US
Telephone Number : 586-776-8877
Fax Number : 586-776-3092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2016
Last Update Date : 06/12/2023

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Directions to “ PHILIP STANLEY VENDITTELLI D.O.” Practice Location

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