Provider Demographics
NPI:1922043389
Name:CIPOLLA, VINCENT ROCCO (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ROCCO
Last Name:CIPOLLA
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:SUITE 500
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-432-6144
Practice Address - Fax:517-432-6150
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2017-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008709204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4650550Medicaid
MI1922043389Medicaid
MIC36088079Medicare PIN
MI4650550Medicaid