Provider Demographics
NPI:1528180841
Name:NOTORANGELO, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NOTORANGELO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-1534
Mailing Address - Country:US
Mailing Address - Phone:231-242-4673
Mailing Address - Fax:231-412-6555
Practice Address - Street 1:229 E 3RD ST
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740
Practice Address - Country:US
Practice Address - Phone:231-242-4673
Practice Address - Fax:231-412-6555
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010160522084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2752410304OtherBCBS
0P19310Medicare ID - Type Unspecified
E70369Medicare UPIN