Provider Demographics
NPI:1245608892
Name:TOCCO, MICHAEL (LAC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TOCCO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:226 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1780
Mailing Address - Country:US
Mailing Address - Phone:248-955-1215
Mailing Address - Fax:
Practice Address - Street 1:1938 BURDETTE ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1982
Practice Address - Country:US
Practice Address - Phone:248-955-1215
Practice Address - Fax:248-963-0800
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5402000096171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist