Individual
FALLON VANESSA DIMAANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2799 W GRAND BLVD STE 3A, DETROIT, MI 48202-2608
(313) 916-2600
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
5101026948
MI
2086X0206X
Surgical Oncology Physician
20A21328
CA
Other
Enumeration date
02/21/2017
Last updated
02/16/2024
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