Provider Demographics
NPI:1821185224
Name:MICHAEL DIGIACOMO DPM INC
Entity Type:Organization
Organization Name:MICHAEL DIGIACOMO DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DIGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-465-8012
Mailing Address - Street 1:445 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3337
Mailing Address - Country:US
Mailing Address - Phone:510-465-8012
Mailing Address - Fax:510-835-1626
Practice Address - Street 1:445 30TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3337
Practice Address - Country:US
Practice Address - Phone:510-465-8012
Practice Address - Fax:510-835-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1909213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E19090Medicaid
CABBB31719BOtherSUBMITTER ID
CAT11093Medicare UPIN
CA0738030001Medicare NSC