Basic Information
| Provider Information | |||||||||
| NPI: | 1609178581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRISOLI | ||||||||
| FirstName: | TIBERIO | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2915 JOHN R ST | ||||||||
| Address2: | APT 306 | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016183856 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23050 WEST RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | BROWNSTOWN TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481831470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346711510 | ||||||||
| FaxNumber: | 7346711570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2010 | ||||||||
| LastUpdateDate: | 05/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4301100388 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 4301100388 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 4301100388 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RC0000X | 4301100388 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.