Provider Demographics
NPI:1962744599
Name:VINCENZO GUGLIELMETTI MD P C
Entity type:Organization
Organization Name:VINCENZO GUGLIELMETTI MD P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENZO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGLIELMETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-343-8987
Mailing Address - Street 1:8031 ORTONVILLE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-4484
Mailing Address - Country:US
Mailing Address - Phone:248-996-8566
Mailing Address - Fax:248-996-8506
Practice Address - Street 1:8031 ORTONVILLE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-4484
Practice Address - Country:US
Practice Address - Phone:248-996-8566
Practice Address - Fax:248-996-8506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6622Medicare PIN