Provider Demographics
NPI:1558344887
Name:DIPONIO, FRANK A JR (DO)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:A
Last Name:DIPONIO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 181038
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48318-1038
Mailing Address - Country:US
Mailing Address - Phone:586-604-3596
Mailing Address - Fax:
Practice Address - Street 1:13700 19 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2702
Practice Address - Country:US
Practice Address - Phone:586-247-6020
Practice Address - Fax:586-247-7048
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558344887OtherINDIVIDUAL NPI
MI201187307OtherTAX I D
MI08-0E00108-0OtherBCBSM PIN
MIFD014926OtherLICENSE
MIFD014926OtherLICENSE
0N87300001Medicare ID - Type Unspecified
MI1558344887OtherINDIVIDUAL NPI
H77206Medicare UPIN