Provider Demographics
NPI:1346425568
Name:MARIO N CORACI PC
Entity Type:Organization
Organization Name:MARIO N CORACI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORACI
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:586-263-8181
Mailing Address - Street 1:16700 21 MILE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16700 21 MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-4887
Practice Address - Country:US
Practice Address - Phone:586-263-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMC0001096213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP45316OtherBLUE CARENETWORK
MI2125505Medicaid
MI480002350OtherTRAVELERS MEDICARE
MIT34328OtherHAP
MI104566OtherPRIORITY HEALTH HMO/PPO
MI1233580002OtherWELLNESS HEALTH PLANS
MI17058OtherM-CARE
MI485505096OtherBLUE CROSS BLUE SHEILD
MI480002350OtherTRAVELERS MEDICARE
MI485505096OtherBLUE CROSS BLUE SHEILD
MIT34328Medicare UPIN