Provider Demographics
NPI:1386657088
Name:DI LIDDO, PAOLO E (DPM)
Entity Type:Individual
Prefix:
First Name:PAOLO
Middle Name:E
Last Name:DI LIDDO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14500 HALL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1229
Mailing Address - Country:US
Mailing Address - Phone:586-247-3764
Mailing Address - Fax:586-247-2673
Practice Address - Street 1:14500 HALL RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1229
Practice Address - Country:US
Practice Address - Phone:586-247-3764
Practice Address - Fax:586-247-2673
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001902213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480H280180OtherBLUE CROSS-BLUE CROSS
PD001902OtherCOMMERCIAL-COMMERCIAL NUMBER
MI439297413Medicaid
PD001902OtherCHAMPUS-CHAMPUS
MI439297413Medicaid
0M23350011Medicare ID - Type Unspecified