Provider Demographics
NPI:1821492752
Name:SIBUG-FRANKLIN, MARITES
Entity Type:Individual
Prefix:
First Name:MARITES
Middle Name:
Last Name:SIBUG-FRANKLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:SIBUG-FRANKLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29255 NORTHWESTERN HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5742
Mailing Address - Country:US
Mailing Address - Phone:248-353-1234
Mailing Address - Fax:248-480-2059
Practice Address - Street 1:29255 NORTHWESTERN HWY STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-5742
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:248-480-2059
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008513225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist