Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901002058 | MI |
Y | 222Z00000X | Podiatrist | 5901002058 | MI |
NPI | 1023062650 |
---|---|
Provider Name | Dr. Anthony Ross Giordano |
First Address | Shelby Twp, MI 48315-3140 |
Second Address | Shelby Twp, MI 48315-3140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 28/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
382469733 | TAX ID FOR PRIMARY LOCATI (01) | MI |
4855010420 | IND BX # (01) | MI |
V02089 | (02) |