Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 5101007489 | MI |
NPI | 1043495039 |
---|---|
Provider Name | Dr. Dale Lee Moliterno |
First Address | Saginaw, MI 48607-1208 |
Second Address | Saginaw, MI 48607-1208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2008 |
Last Update Date | 25/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0157313895 | HEALTH PLUS OF MICHIGAN (01) | MI |
070G310660 | BLUE CROSS BLUE SHIELD (01) | MI |
080G310660 | BLUE CARE NETWORK OF MICHIGAN (01) | MI |
1043495039 | (05) | MI |
1043495039 | MOLINA HEALTHCARE OF MICHIGAN (01) | MI |
1058377 | MCLAREN HEALTH PLAN OF MICHIGAN (01) | MI |
180962 | GREAT LAKES HEALTH PLAN/UNITED HEALTHCARE (01) | MI |
381908328 | HCAP (01) | MN |
381908328 | PRIORITY HEALTH (01) | MI |
381908328-464 | CARE SOURCE OF MICHIGAN (01) | MN |
58146 | HEALTHPLAN OF MICHIGAN (01) | MN |
E25719 | (02) | MI |