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NPI Code Detail

MEDICARE: DR. ROBERT G MICELI MD

MEDICARE: DR. ROBERT G MICELI MD
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
1174400000XSpecialist41244MA

General Provider Information

NPI Number : 1891776175
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT G MICELI MD
Provider Business Mailing Address
First Line : PO BOX 198
Second Line :
City : GLOUCESTER
State : MA
Zip : 01931-0198
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 CITY PL
Second Line : MET LIFE, 7TH FLOOR
City : HARTFORD
State : CT
Zip : 06103-3432
Country : US
Telephone Number : 860-308-1348
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 07/08/2007

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