Provider Demographics
NPI:1134823735
Name:DIGRANDE, MARC ANTHONY (DPM)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:DIGRANDE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19984 RIVERWOODS CT # 2
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5762
Mailing Address - Country:US
Mailing Address - Phone:248-739-2600
Mailing Address - Fax:
Practice Address - Street 1:16001 W 9 MILE RD FL 2
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4818
Practice Address - Country:US
Practice Address - Phone:248-849-3415
Practice Address - Fax:248-849-2994
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program