Provider Demographics
NPI:1053563296
Name:MARIVIC D. MASSAND MD,PLLC
Entity type:Organization
Organization Name:MARIVIC D. MASSAND MD,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:PRIBHDAS
Authorized Official - Last Name:MASSAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-737-8000
Mailing Address - Street 1:971 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1252
Mailing Address - Country:US
Mailing Address - Phone:313-885-4489
Mailing Address - Fax:313-899-7092
Practice Address - Street 1:971 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1252
Practice Address - Country:US
Practice Address - Phone:313-885-4489
Practice Address - Fax:313-899-7092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036945251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health