Provider Demographics
NPI:1609178581
Name:FRISOLI, TIBERIO MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIBERIO
Middle Name:MICHELE
Last Name:FRISOLI
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 1:2915 JOHN R ST
Mailing Address - Street 2:APT 306
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2908
Mailing Address - Country:US
Mailing Address - Phone:201-618-3856
Mailing Address - Fax:
Practice Address - Street 1:23050 WEST RD STE 120
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1470
Practice Address - Country:US
Practice Address - Phone:734-671-1510
Practice Address - Fax:734-671-1570
Is Sole Proprietor?:No
Enumeration Date:2010-11-26
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100388207P00000X, 207R00000X, 208M00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist