Provider Demographics
NPI:1649216128
Name:DIPONIO, CAROLYN ELIZABETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:DIPONIO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 W M 72 HWY
Mailing Address - Street 2:P O BOX 607
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-7462
Mailing Address - Country:US
Mailing Address - Phone:989-348-3090
Mailing Address - Fax:989-348-9547
Practice Address - Street 1:6251 W M 72 HWY
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-7462
Practice Address - Country:US
Practice Address - Phone:989-348-3090
Practice Address - Fax:989-348-9547
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICD000556213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI132103553Medicaid
MIT98977Medicare UPIN
MI132103553Medicaid