Provider Demographics
NPI:1508958737
Name:GUGLIELMETTI, VINCENZO (MD)
Entity Type:Individual
Prefix:
First Name:VINCENZO
Middle Name:
Last Name:GUGLIELMETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:29877 TELEGRAPH RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1332
Mailing Address - Country:US
Mailing Address - Phone:248-377-4188
Mailing Address - Fax:248-223-9302
Practice Address - Street 1:1375 S. LAPEER RD.
Practice Address - Street 2:STE. 106
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360
Practice Address - Country:US
Practice Address - Phone:248-693-9040
Practice Address - Fax:248-696-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH35718Medicare UPIN