Provider Demographics
NPI:1043372840
Name:MARSILI, MICHAEL EMIL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EMIL
Last Name:MARSILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4331
Mailing Address - Country:US
Mailing Address - Phone:415-458-9339
Mailing Address - Fax:888-706-4141
Practice Address - Street 1:655 CANYON RD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4331
Practice Address - Country:US
Practice Address - Phone:415-458-9339
Practice Address - Fax:888-706-4141
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0G453162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49982Medicare UPIN