Provider Demographics
NPI:1669454146
Name:MASSERANT, JOHN CURTIS (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CURTIS
Last Name:MASSERANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1046 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3113
Mailing Address - Country:US
Mailing Address - Phone:734-457-9034
Mailing Address - Fax:734-457-9037
Practice Address - Street 1:1046 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3113
Practice Address - Country:US
Practice Address - Phone:734-457-9034
Practice Address - Fax:734-457-9037
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIJM076801207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11522OtherHEALTHPLAN OF MICHIGAN
MI7240060OtherAETNA
MI104587830Medicaid
MI1605801782OtherBLUE CARE NETWORK
MI03738OtherPARAMOUNT
MIP00236355OtherRAILROAD MEDICARE
MI1605801782OtherBLUE CROSS BLUE SHIELD
H28569Medicare UPIN
MI7240060OtherAETNA
MI104587830Medicaid