Provider Demographics
NPI:1831110774
Name:DRS IACOBELLI & DIGREGORIO, P.C.
Entity Type:Organization
Organization Name:DRS IACOBELLI & DIGREGORIO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KNOBLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-263-7200
Mailing Address - Street 1:16510 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1106
Mailing Address - Country:US
Mailing Address - Phone:586-263-7200
Mailing Address - Fax:586-263-5331
Practice Address - Street 1:16510 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1106
Practice Address - Country:US
Practice Address - Phone:586-263-7200
Practice Address - Fax:586-263-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty