Provider Demographics
NPI:1104898667
Name:PACIS BIEDERMAN, MARIA THERESA
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:THERESA
Last Name:PACIS BIEDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:THERESA
Other - Last Name:PACIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3310 W BIG BEAVER RD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2809
Mailing Address - Country:US
Mailing Address - Phone:248-792-5200
Mailing Address - Fax:248-712-4214
Practice Address - Street 1:3310 W BIG BEAVER RD
Practice Address - Street 2:SUITE 137
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2809
Practice Address - Country:US
Practice Address - Phone:248-792-5200
Practice Address - Fax:248-712-4214
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013744207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI482350811Medicaid
MII18731Medicare UPIN
MIH27194009Medicare ID - Type Unspecified