Provider Demographics
NPI:1457752974
Name:CLAYSEN, MARISA KARCZ (PA-C)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:KARCZ
Last Name:CLAYSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:KARCZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1769 BOWERS ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6886
Mailing Address - Country:US
Mailing Address - Phone:248-252-2829
Mailing Address - Fax:
Practice Address - Street 1:725 S ADAMS RD STE 266
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6999
Practice Address - Country:US
Practice Address - Phone:248-252-2829
Practice Address - Fax:248-633-8825
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant