Provider Demographics
NPI:1013131812
Name:MARC D. MEISSNER , MD, CM, PLLC
Entity Type:Organization
Organization Name:MARC D. MEISSNER , MD, CM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEISSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-966-1154
Mailing Address - Street 1:25270 SOUTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2081
Mailing Address - Country:US
Mailing Address - Phone:248-559-1942
Mailing Address - Fax:
Practice Address - Street 1:25270 SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2081
Practice Address - Country:US
Practice Address - Phone:248-559-1942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055452207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4381344Medicaid
MI4381344Medicaid