Provider Demographics
NPI:1689614554
Name:AULICINO, MICHAEL ROY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROY
Last Name:AULICINO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5974
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:HURON VALLEY SINAI HOSPITAL PATHOLOGY
Practice Address - Street 2:1 WILLIAM CARLS DR
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-1271
Practice Address - Country:US
Practice Address - Phone:248-937-3435
Practice Address - Fax:248-937-5026
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068065207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630185Medicare PIN