Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC005649-L | PA |
Y | 222Z00000X | Podiatrist | SC005649-L | PA |
NPI | 1053316851 |
---|---|
Provider Name | Dr. Michael Avato |
First Address | Philadelphia, PA 19152-2733 |
Second Address | Philadelphia, PA 19152-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1011369110001 | (05) | PA |
V00763 | (02) |