Provider Demographics
NPI:1043495039
Name:MOLITERNO, DALE LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:LEE
Last Name:MOLITERNO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 LAPEER
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:501 LAPEER
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48607-1208
Practice Address - Country:US
Practice Address - Phone:989-759-6300
Practice Address - Fax:989-759-6454
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007489208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN58146OtherHEALTHPLAN OF MICHIGAN
MI180962OtherGREAT LAKES HEALTH PLAN/UNITED HEALTHCARE
MN381908328-464OtherCARE SOURCE OF MICHIGAN
MI0157313895OtherHEALTH PLUS OF MICHIGAN
MI1058377OtherMCLAREN HEALTH PLAN OF MICHIGAN
MI070G310660OtherBLUE CROSS BLUE SHIELD
MI1043495039Medicaid
MI080G310660OtherBLUE CARE NETWORK OF MICHIGAN
MN381908328OtherHCAP
MI1043495039OtherMOLINA HEALTHCARE OF MICHIGAN
MI381908328OtherPRIORITY HEALTH
MN381908328OtherHCAP
MI1043495039Medicaid