Provider Demographics
NPI:1083746671
Name:MARCIANO AGOSTINELLI, PAOLO (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:
Last Name:MARCIANO AGOSTINELLI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:INTERVENTIONAL RADIOLOGY
Mailing Address - Street 2:3601 W 13 MILE RD
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6712
Mailing Address - Country:US
Mailing Address - Phone:248-898-7456
Mailing Address - Fax:248-898-4316
Practice Address - Street 1:INTERVENTIONAL RADIOLOGY
Practice Address - Street 2:3601 W 13 MILE RD
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-7456
Practice Address - Fax:248-898-4316
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20040127382085R0202X
MI43010940232085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology