Davide Iacobelli, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301045230 Issued in MI

Practice address

16510 19 Mile Rd
Clinton Township, MI 48038

Phone

(586) 263-7200

Fax

(586) 286-8007

NPI assigned

Jan 3, 2006

Last updated

Sep 25, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michigan Center for Dermatology & Pathology, PLLC

  • Medical Specialty Clinic/Center
  • Clinton Township, MI
  • NPI 1346234507
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1992783872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16510 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "48038",
            "telephone_number": "586-263-7200",
            "fax_number": "586-286-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16510 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "48038",
            "telephone_number": "586-263-7200",
            "fax_number": "586-286-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACOBELLI",
        "first_name": "DAVIDE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301045230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1044574",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Hutchinson, BSW, QMHP, QIDP
• Lori Ann Hyde, O.T.
• Zainab Hyoori, PHARMACIST
• Shannon Hyso
• Larisa Iacoban
• Angela K Ianitelli, PA-C
• Andy Ibrahim
• Elmoataz Ibrahim, M.D.
• Icare Counseling of Michigan, PLLC
• Jill Ann Idicula

• Dermatology Physician in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.