Provider Demographics
NPI:1063508711
Name:IANDIORIO, MICHELLE J (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:IANDIORIO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2745
Practice Address - Country:US
Practice Address - Phone:505-272-8950
Practice Address - Fax:505-272-3202
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-02-01
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Provider Licenses
StateLicense IDTaxonomies
NM2006-0418207RI0200X
NMMD2006-0418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM207R00000XMedicare UPIN