Provider Demographics
NPI:1932223401
Name:BOMMARITO, SALVATORE VITO (DO)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:VITO
Last Name:BOMMARITO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18930 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4981
Mailing Address - Country:US
Mailing Address - Phone:586-489-1305
Mailing Address - Fax:
Practice Address - Street 1:50 N PERRY
Practice Address - Street 2:
Practice Address - City:PONTAIC
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:248-338-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006196207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology