Provider Demographics
NPI:1568857514
Name:MUNGILLO, MICHAEL VITO (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VITO
Last Name:MUNGILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7995 CALL PKWY
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-4114
Mailing Address - Country:US
Mailing Address - Phone:585-345-1779
Mailing Address - Fax:585-345-1862
Practice Address - Street 1:7995 CALL PKWY
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-4114
Practice Address - Country:US
Practice Address - Phone:585-345-1779
Practice Address - Fax:585-345-1862
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine