Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 275080 | NY |
N | 207RI0011X | Interventional Cardiology | 275080 | NY |
NPI | 1023252293 |
---|---|
Provider Name | Dr. Michail Vitellas |
First Address | Binghamton, NY 13905-1048 |
Second Address | Johnson City, NY 13790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2009 |
Last Update Date | 24/07/2018 |