Provider Demographics
NPI:1295977007
Name:FRANK A. DIPONIO JR. D.O. P.C.
Entity type:Organization
Organization Name:FRANK A. DIPONIO JR. D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIPONIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:586-604-3596
Mailing Address - Street 1:PO BOX 181038
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48318-1038
Mailing Address - Country:US
Mailing Address - Phone:586-604-3596
Mailing Address - Fax:
Practice Address - Street 1:29250 HERITAGE PARKWAY
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092
Practice Address - Country:US
Practice Address - Phone:586-578-0124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFD014926207Q00000X
MI#5101014926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI#08-0E00108-0OtherBCBSM
MIH77206Medicare UPIN
MIMI1839Medicare PIN