Active NPI
Kevin J Damico, CNMT & AART(N)
- Nuclear Medicine Technology Radiologic Technologist
- Plymouth, MI
National Provider Identifier
1306990767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Medicine Technology Radiologic Technologist
- License
- 007988 & 193875
- Practice address
- 983 Wing St
Plymouth, MI 48170-1725 - Phone
- (734) 414-7056
- Fax
- (734) 414-9925
- NPI assigned
- Jan 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nuclear Medicine Technology Radiologic Technologist | 2471N0900X | 007988 & 193875 | MI | Primary |
Addresses
Primary practice location
983 Wing St
Plymouth, MI 48170-1725
Mailing address
983 Wing St
Plymouth, MI 48170-1725
Phone (734) 414-7056
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007988 & 193875 | MI | MD | Nuclear Medicine Technology Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306990767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "983 WING ST",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481701725",
"telephone_number": "734-414-7056",
"fax_number": "734-414-9925"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "983 WING ST",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481701725",
"telephone_number": "734-414-7056",
"fax_number": "734-414-9925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAMICO",
"first_name": "KEVIN",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "CNMT & AART(N)",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2471N0900X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Nuclear Medicine Technology",
"state": "MI",
"license": "007988 & 193875",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.