| Doctor Name: | DR. MICHAEL MATTHEW DOMINELLO |
| NPI Number: | 1003135500 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 5101019388 |
| Business Practice Address: | 4100 John R Detroit, MI - 482012013 |
| Business Phone Number: | 8005276266 |
| Business Fax Number: | 3135769640 |
| Mailing Address: | 1560 E Maple Rd, Suite 400 - Credentialing Department TROY |
| State: | MI |
| Postal Code: | 480831138 |
| Phone Number: | 8005276266 |
| Fax Number: | 3135769640 |
| NPI Enumeration Date: | 05/24/2010 |
| NPI Last Update Date: | 07/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0001X |
| License Number: | 5101019388 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Radiation Oncology |
| Taxonomy Definition: | A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |