Provider Demographics
NPI:1639193048
Name:MARCHETTA, STEVEN M (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:MARCHETTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3455 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2559
Mailing Address - Country:US
Mailing Address - Phone:810-694-0600
Mailing Address - Fax:810-694-0601
Practice Address - Street 1:3455 REGENCY PARK DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2559
Practice Address - Country:US
Practice Address - Phone:810-694-0600
Practice Address - Fax:810-694-0601
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISM007572207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1402852Medicaid
MI0101325OtherHEALTH PLUS
240003353OtherRRMEDICARE
MI204039OtherMCLAREN HEALTH ADVANTAGE
MI381862593002OtherCIGNA
MIE26756OtherHAP
MI5251217OtherBCBSM
MI5251217OtherBCBSM
MI1402852Medicaid