Provider Demographics
NPI:1972670263
Name:SCAFIDI, MICHELANGELO (CERTIFIED PEDORTHIST)
Entity Type:Individual
Prefix:
First Name:MICHELANGELO
Middle Name:
Last Name:SCAFIDI
Suffix:
Gender:M
Credentials:CERTIFIED PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-3152
Mailing Address - Country:US
Mailing Address - Phone:708-453-4900
Mailing Address - Fax:708-453-3338
Practice Address - Street 1:8344 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-3152
Practice Address - Country:US
Practice Address - Phone:708-453-4900
Practice Address - Fax:708-453-3338
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1272630001Medicare NSC