Organization
MATTHEW L VISCONTI MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW L VISCONTI M.D. (PRESIDENT)
(231) 439-9700
Entity
Organization
Contact information
Practice address
1114 CHARLEVOIX AVE, PETOSKEY, MI 49770-9701
(231) 439-9700
(231) 439-9709
Mailing address
PO BOX 731, PETOSKEY, MI 49770-0731
(231) 439-9700
(231) 439-9709
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104926793
—
MI
Enumeration date
06/26/2006
Last updated
05/01/2018
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