Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 5151014447 | MI |
NPI | 1003443763 |
---|---|
Provider Name | Anthony Peter Di Ponio |
First Address | Clinton Township, MI 48038-3504 |
Second Address | Clinton Township, MI 48038-3504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2020 |
Last Update Date | 29/03/2021 |