Provider Demographics
NPI:1225205149
Name:VITTORIO, ADDIE CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:ADDIE
Middle Name:CHRISTINE
Last Name:VITTORIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADDIE
Other - Middle Name:CHRISTINE
Other - Last Name:LICARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2624
Mailing Address - Country:US
Mailing Address - Phone:218-249-8800
Mailing Address - Fax:218-249-8828
Practice Address - Street 1:1400 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-2624
Practice Address - Country:US
Practice Address - Phone:218-249-8800
Practice Address - Fax:218-249-8828
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1225205149OtherGROUP HEALTH
MN1225205149Medicaid
P00767175OtherMEDICARE RAILROAD
01-37337OtherMEDICA
MN1225205149OtherBCBS MN
WI1225205149OtherGROUP HEALTH