Provider Demographics
NPI:1528293925
Name:PIETRANGELO, NICOLAS JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:JOSEPH
Last Name:PIETRANGELO
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 1:19212 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9109
Mailing Address - Country:US
Mailing Address - Phone:616-842-6813
Mailing Address - Fax:
Practice Address - Street 1:19212 N SHORE DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-9109
Practice Address - Country:US
Practice Address - Phone:616-842-6813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006774207L00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology