Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 4301058209 | MI |
NPI | 1003809575 |
---|---|
Provider Name | Mark Gregory Marrone |
First Address | Livonia, MI 48152-5007 |
Second Address | Livonia, MI 48152-5007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 06/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10-3328315 | (05) | MI |
G80797 | (02) |