Provider Demographics
NPI:1013102391
Name:MASSAND, MARIVIC D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIVIC
Middle Name:D
Last Name:MASSAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1252
Mailing Address - Country:US
Mailing Address - Phone:313-885-4489
Mailing Address - Fax:
Practice Address - Street 1:971 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1252
Practice Address - Country:US
Practice Address - Phone:313-885-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine