Individual
MICHAEL WARREN PETTINELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
300 W CONAN ST, ELY, MN 55731-1145
(218) 365-7900
Mailing address
300 W CONAN ST, ELY, MN 55731-1145
(218) 365-7900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
40416
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31625400
—
WI
05
—
652203
—
MN
Enumeration date
06/27/2006
Last updated
06/27/2011
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