Provider Demographics
NPI:1235116401
Name:PISCIOTTA, MICHELE Q (PHYSICIAN)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:Q
Last Name:PISCIOTTA
Suffix:
Gender:F
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4502 OLD PASS RD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2585
Mailing Address - Country:US
Mailing Address - Phone:228-863-9977
Mailing Address - Fax:228-863-9912
Practice Address - Street 1:4502 OLD PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2585
Practice Address - Country:US
Practice Address - Phone:228-863-9977
Practice Address - Fax:228-863-9912
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120940Medicaid
MS00120940Medicaid