Provider Demographics
NPI:1881653301
Name:MARINAS, EDWIN B (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:B
Last Name:MARINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8924 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0089
Mailing Address - Country:US
Mailing Address - Phone:517-332-5050
Mailing Address - Fax:517-332-8011
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:SPARROW HOSPITAL
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-1000
Practice Address - Fax:517-483-2837
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI058011207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3367476Medicaid
G55080Medicare UPIN
MIOM14410008Medicare ID - Type Unspecified