Provider Demographics
NPI:1306990767
Name:DAMICO, KEVIN J (CNMT & AART(N))
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:DAMICO
Suffix:
Gender:M
Credentials:CNMT & AART(N)
Other - Prefix:
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Mailing Address - Street 1:983 WING ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1725
Mailing Address - Country:US
Mailing Address - Phone:734-414-7056
Mailing Address - Fax:734-414-9925
Practice Address - Street 1:983 WING ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1725
Practice Address - Country:US
Practice Address - Phone:734-414-7056
Practice Address - Fax:734-414-9925
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI007988 & 1938752471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology