Provider Demographics
NPI:1093781668
Name:FIORUCCI, STEVEN J (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:FIORUCCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:WATERSMEET
Mailing Address - State:MI
Mailing Address - Zip Code:49969-0309
Mailing Address - Country:US
Mailing Address - Phone:906-358-0260
Mailing Address - Fax:906-358-0277
Practice Address - Street 1:N4698 HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:WATERSMEET
Practice Address - State:MI
Practice Address - Zip Code:49969
Practice Address - Country:US
Practice Address - Phone:906-358-0260
Practice Address - Fax:906-358-0277
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE80779Medicare UPIN