Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 4301070517 | MI |
NPI | 1023106507 |
---|---|
Provider Name | Vittorio M Morreale |
First Address | Shelby Twp, MI 48315-3140 |
Second Address | Shelby Twp, MI 48315-3140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 22/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140E008790 | BCBSM (01) | MI |
4376120 | (05) | MI |