Provider Demographics
NPI:1184374639
Name:DICARO, MICHAEL VINCENT (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VINCENT
Last Name:DICARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 W SOFTWIND DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-3247
Mailing Address - Country:US
Mailing Address - Phone:520-429-0301
Mailing Address - Fax:
Practice Address - Street 1:1701 W CHARLESTON BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2312
Practice Address - Country:US
Practice Address - Phone:702-660-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program