Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 4301055901 | MI |
NPI | 1043290232 |
---|---|
Provider Name | Robert Lewis Marchese |
First Address | Roseville, MI 48066-4467 |
Second Address | Roseville, MI 48066-4467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4832040-10 | (05) | MI |
G48837 | (02) |