Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 5101024502 | MI |
NPI | 1003267824 |
---|---|
Provider Name | Dr. Robert Michael Camilletti |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Brighton, MI 48114-7005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 12/07/2019 |