Provider Demographics
NPI:1518923325
Name:MARCUS, ANDREW L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:MARCUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 PELHAM ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3852
Mailing Address - Country:US
Mailing Address - Phone:313-730-9100
Mailing Address - Fax:313-730-9104
Practice Address - Street 1:3815 PELHAM ST
Practice Address - Street 2:SUITE 14
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3852
Practice Address - Country:US
Practice Address - Phone:313-730-9100
Practice Address - Fax:313-730-9104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM0425402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA76320Medicare UPIN
MIOM73780Medicare ID - Type Unspecified