Individual
PHILIP STANLEY VENDITTELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
18303 E 10 MILE RD STE 100, ROSEVILLE, MI 48066-4989
(586) 776-8877
(586) 776-3092
Mailing address
22101 MOROSS RD FL 2, DETROIT, MI 48236-2148
(313) 343-4612
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101022293
MI
207RC0000X
Cardiovascular Disease Physician
51024546
MI
207RI0011X
Interventional Cardiology Physician
Primary
5315204612
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5101024546
—
MI
Enumeration date
05/08/2016
Last updated
06/12/2023
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