Provider Demographics
NPI:1619935921
Name:CATALAN, MARISSA B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:B
Last Name:CATALAN
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 1:22500 METROPOLITAN PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1904
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:36500 S GRATIOT AVE
Practice Address - Street 2:STE. 101
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1772
Practice Address - Country:US
Practice Address - Phone:586-493-3732
Practice Address - Fax:586-493-3739
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1021715OtherMHP HAN
MI4956881Medicaid
MI4733330Medicaid
MI350D410030OtherBCBSM BCN BLUE CHOICE
MI4733330Medicaid