Provider Demographics
NPI:1225610686
Name:CARNEY, MARIANNE LOUISE (DPM)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:LOUISE
Last Name:CARNEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 BYRON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2046
Mailing Address - Country:US
Mailing Address - Phone:248-953-7461
Mailing Address - Fax:
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-573-7470
Practice Address - Fax:586-573-0850
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
20004022OtherRESIDENT