Provider Demographics
NPI:1164950341
Name:MAFFETONE, DOMINIC JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:JAMES
Last Name:MAFFETONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6379 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:MI
Mailing Address - Zip Code:48451-8706
Mailing Address - Country:US
Mailing Address - Phone:810-735-7847
Mailing Address - Fax:
Practice Address - Street 1:6379 SILVER LAKE RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:MI
Practice Address - Zip Code:48451-8706
Practice Address - Country:US
Practice Address - Phone:810-735-7847
Practice Address - Fax:810-249-4312
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301501877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine