Provider Demographics
NPI:1235767856
Name:VISCONTI, MICHAEL JAMES (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:VISCONTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5096
Mailing Address - Country:US
Mailing Address - Phone:734-495-1506
Mailing Address - Fax:734-495-1780
Practice Address - Street 1:361 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5096
Practice Address - Country:US
Practice Address - Phone:734-495-1506
Practice Address - Fax:734-495-1780
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101027977207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology