Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 036124370 | IL |
N | 208200000X | Surgeon | 051916 | CT |
N | 208600000X | Surgeon | 051916 | CT |
N | 2086S0102X | Surgical Critical Care | 051916 | CT |
Y | 2086S0102X | Surgical Critical Care | 55156 | AZ |
NPI | 1124270053 |
---|---|
Provider Name | Michael Dominick Diodato JR. |
First Address | Phoenix, AZ 85013-4220 |
Second Address | Phoenix, AZ 85013-4220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2008 |
Last Update Date | 29/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001519164 | (05) | CT |