Individual
VIRGIL A DIBIASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
707 N MICHIGAN ST STE 102, SOUTH BEND, IN 46601-1068
(574) 647-8542
(574) 647-8549
Mailing address
PO BOX 772988, DETROIT, MI 48277-2988
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01042651A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100386310
—
IN
01
—
M32727008
MEDICARE
—
Enumeration date
06/23/2006
Last updated
01/06/2023
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