Organization
MECOSTA COUNTY RADIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLASE VITELLO M.D. (OWNER/PRESIDENT)
(231) 592-4212
Entity
Organization
Contact information
Practice address
605 OAK ST, BIG RAPIDS, MI 49307-2048
(231) 592-4212
(231) 592-4343
Mailing address
PO BOX 1108, ATTN: LYNDA THOMPSON, ANN ARBOR, MI 48106-1108
(734) 677-7400
(734) 677-7407
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB9242
RR MEDICARE
MI
Enumeration date
07/30/2006
Last updated
08/22/2020
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