Provider Demographics
NPI:1669575668
Name:DE MARCO, MICHAEL FRANK (DPM)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANK
Last Name:DE MARCO
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 1:101 LAMAR SMITH RD
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-4086
Mailing Address - Country:US
Mailing Address - Phone:601-795-9840
Mailing Address - Fax:601-795-9840
Practice Address - Street 1:101 LAMAR SMITH RD
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470
Practice Address - Country:US
Practice Address - Phone:601-795-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002457213ES0131X
MS80232213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery