Individual
DR. MICHAEL C DICELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1188 N 15TH AVE STE 3, BOZEMAN, MT 59715-3290
(406) 582-1111
(406) 582-1112
Mailing address
1188 N 15TH AVE STE 3, BOZEMAN, MT 59715-3290
(406) 582-1111
(406) 582-1112
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
11976
MT
207K00000X
Allergy & Immunology Physician
42-000-9879
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01961568
—
NY
01
—
03V100
MVP
VT
05
—
0VN1993
—
VT
01
—
48079
BLUE CROSS BLUE SHIELD VT
VT
01
—
7525992-001
CIGNA
VT
01
—
96G431
BCBS NORTHEAST NEW YORK
NY
Enumeration date
06/14/2005
Last updated
07/28/2023
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