Provider Demographics
NPI:1154577476
Name:INDELICATO, MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:INDELICATO
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Gender:M
Credentials:DO
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Mailing Address - Street 1:39 CROSS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1670
Mailing Address - Country:US
Mailing Address - Phone:978-532-4077
Mailing Address - Fax:978-531-0324
Practice Address - Street 1:39 CROSS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1670
Practice Address - Country:US
Practice Address - Phone:978-532-4077
Practice Address - Fax:978-531-0324
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2017-03-17
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Provider Licenses
StateLicense IDTaxonomies
MA265526207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHM9382Medicare UPIN