Provider Demographics
NPI:1487628863
Name:DIPONIO, EMMA CRISTINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:CRISTINA
Last Name:DIPONIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0767
Mailing Address - Country:US
Mailing Address - Phone:906-282-8500
Mailing Address - Fax:855-834-6292
Practice Address - Street 1:1115 S HEMLOCK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3800
Practice Address - Country:US
Practice Address - Phone:906-282-8500
Practice Address - Fax:906-282-8500
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI564172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1487628863Medicaid
WI076500367Medicare PIN
WI1487628863Medicaid