Provider Demographics
NPI:1093811515
Name:MARESCA, CARLOTTA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOTTA
Middle Name:M
Last Name:MARESCA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-2833
Mailing Address - Fax:989-583-1440
Practice Address - Street 1:5400 MACKINAW RD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9515
Practice Address - Country:US
Practice Address - Phone:989-583-5060
Practice Address - Fax:989-583-5046
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM042961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020042476OtherRAILROAD MEDICARE #
MI1009436OtherMCLAREN HEALTH PLAN #
MI104415OtherGREAT LAKES HEALTH PLAN
MIC3006OtherM-CARE PROVIDER NUMBER
MI101590592Medicaid
MI0207311781OtherBCBS PROVIDER ID
MI382684672OtherTAX ID
MI0207310861OtherHEALTHPLUS PROVIDER #
MI101590592Medicaid
MI1009436OtherMCLAREN HEALTH PLAN #