Individual
DR. MICHAEL MATTHEW DOMINELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4100 JOHN R, DETROIT, MI 48201-2013
(800) 527-6266
(313) 576-9640
Mailing address
1560 E MAPLE RD, SUITE 400 - CREDENTIALING DEPARTMENT, TROY, MI 48083-1138
(800) 527-6266
(313) 576-9640
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
5101019388
MI
Other
Enumeration date
05/24/2010
Last updated
07/28/2015
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