Provider Demographics
NPI:1548268808
Name:SCIAMANNA, DAVID S (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:SCIAMANNA
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 1:1105 6TH ST
Mailing Address - Street 2:MUNSON MEDICAL CTR-NICU
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2349
Mailing Address - Country:US
Mailing Address - Phone:231-935-5544
Mailing Address - Fax:
Practice Address - Street 1:1105 6TH ST
Practice Address - Street 2:MUNSON MEDICAL CTR-NICU
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2349
Practice Address - Country:US
Practice Address - Phone:231-935-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010069992080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23561OtherPRIORITY HEALTH
MI3552810144OtherBLUE CROSS
MIP64750OtherBLUE CARE NETWORK
MI4717354Medicaid
MI50027456OtherALLIANCE HEALTH
MIP64750OtherBLUE CARE NETWORK