Provider Demographics
NPI:1235229345
Name:MOLINARI, PIETRO S (PA)
Entity Type:Individual
Prefix:
First Name:PIETRO
Middle Name:S
Last Name:MOLINARI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MI
Mailing Address - Zip Code:49837-2355
Mailing Address - Country:US
Mailing Address - Phone:906-428-3234
Mailing Address - Fax:
Practice Address - Street 1:3401 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1300
Practice Address - Country:US
Practice Address - Phone:906-786-5707
Practice Address - Fax:906-786-4004
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004352363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00344628OtherRAILROAD MEDICARE
Q34531Medicare UPIN
MIP29950008Medicare PIN