Mastrogiacomo, Anthony Marc

Mastrogiacomo, Anthony Marc is an individual health care provider with primary practice located at 22245 Pontiac Trl , South Lyon MI 48178-1639. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Podiatrist is his primary health care specialty. Mastrogiacomo, Anthony Marc can be contacted via phone (248) 486-8886.

Contact Information

Primary practice address
22245 Pontiac Trl South Lyon MI 48178-1639
Phone: (248) 486-8886
Fax: (248) 486-8887
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X AM001831 Michigan
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X AM001831 Michigan

Profile Details

NPI number 1720055387
LBN Legal business name Mastrogiacomo, Anthony Marc
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 2nd, 2006
Last updated Feb 26th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1720055387 NPPES
Michigan MEDICAID 4619433

Popular Providers