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NPI Code Detail

MEDICARE: VINCENT DEMATIO

MEDICARE: VINCENT DEMATIO
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 Physician35.134465OH
2207R00000XInternal Medicine Physician4301118997MI

General Provider Information

NPI Number : 1982067096
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT DEMATIO
Provider Business Mailing Address
First Line : 4954 STILLWAGON RD
Second Line :
City : WEST BRANCH
State : MI
Zip : 48661-9662
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2525 7TH AVE S
Second Line :
City : ESCANABA
State : MI
Zip : 49829-1131
Country : US
Telephone Number : 248-860-4634
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2016
Last Update Date : 10/12/2021

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Directions to “ VINCENT DEMATIO ” Practice Location

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