Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 5101025557 | MI |
NPI | 1003231796 |
---|---|
Provider Name | Michael Maceroni |
First Address | Wyandotte, MI 48192-4668 |
Second Address | Wyandotte, MI 48192-4668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2014 |
Last Update Date | 04/06/2020 |