Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101021238 | MI |
N | 207Q00000X | Family Doctor | 5101021238 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | 5315088343 | MI |
NPI | 1639583206 |
---|---|
Provider Name | John Morasso |
First Address | Troy, MI 48084-1744 |
Second Address | West Bloomfield, MI 48322-4930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2014 |
Last Update Date | 16/12/2019 |