Provider Demographics
NPI:1366635971
Name:MICELI, MARISA HAYDEE (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:HAYDEE
Last Name:MICELI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3621 SOUTH STATE STREET
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DR
Practice Address - Street 2:3RD FLOOR TAUBMAN CENTER RECP D
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5352
Practice Address - Country:US
Practice Address - Phone:734-936-5899
Practice Address - Fax:734-615-2156
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301095275207R00000X, 207RI0200X
NMRS 2007-0363207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine