Provider Demographics
NPI:1952565897
Name:LOPICCOLO, MATTEO C (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTEO
Middle Name:C
Last Name:LOPICCOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:43151 DALCOMA DR STE 4
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:
Practice Address - Street 1:361 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5096
Practice Address - Country:US
Practice Address - Phone:734-495-1506
Practice Address - Fax:734-495-1780
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301092937207ND0101X
OH35121523207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery