Individual
DR. ANTHONY MARC MASTROGIACOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
22245 PONTIAC TRL, SOUTH LYON, MI 48178-1639
(248) 486-8886
(248) 486-8887
Mailing address
22245 PONTIAC TRL, SOUTH LYON, MI 48178-1639
(248) 486-8886
(248) 486-8887
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
AM001831
MI
213ES0103X
Foot & Ankle Surgery Podiatrist
AM001831
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4619433
—
MI
Enumeration date
03/02/2006
Last updated
02/26/2008
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