Provider Demographics
NPI:1588635882
Name:MARIONA, FEDERICO (MD)
Entity Type:Individual
Prefix:
First Name:FEDERICO
Middle Name:
Last Name:MARIONA
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 1:44405 WOODWARD AVE
Mailing Address - Street 2:ROOM 571
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:248-858-6762
Mailing Address - Fax:248-828-3761
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:ROOM 571
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-6762
Practice Address - Fax:248-858-3761
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031507207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4426141Medicaid
B46261Medicare UPIN