Provider Demographics
NPI:1720245319
Name:DI IORIO, MICHAEL MARIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARIO
Last Name:DI IORIO
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 1:5301A DAVIS LN STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-3961
Mailing Address - Country:US
Mailing Address - Phone:512-693-8344
Mailing Address - Fax:
Practice Address - Street 1:5301A DAVIS LN STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-3961
Practice Address - Country:US
Practice Address - Phone:512-693-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT49759202K00000X, 2085R0202X, 2085R0204X, 208D00000X
TXQ19752085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ420665Medicaid
AZZ130234Medicare PIN
CTP00951230Medicare PIN
CTD100037356Medicare PIN
CTD400050310Medicare PIN
CTDR2994Medicare PIN