Individual
MASSIMILIANO P VITALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17900 23 MILE RD, SUITE 303, MACOMB, MI 48044-1161
(586) 868-9800
(586) 868-9801
Mailing address
17900 23 MILE RD, SUITE 303, MACOMB, MI 48044-1161
(586) 868-9800
(586) 868-9801
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301076839
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700E031610
BCBSM GROUP PIN
MI
Enumeration date
01/06/2006
Last updated
05/08/2015
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