Provider Demographics
NPI:1134130834
Name:KLING, MARCIA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELIZABETH
Last Name:KLING
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 1:47733 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3372
Mailing Address - Country:US
Mailing Address - Phone:586-254-2534
Mailing Address - Fax:586-254-3889
Practice Address - Street 1:47733 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48317-3372
Practice Address - Country:US
Practice Address - Phone:586-254-2534
Practice Address - Fax:586-254-3889
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK4301060329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4439533Medicaid
MIF97588Medicare UPIN
MION51950Medicare ID - Type Unspecified