Provider Demographics
NPI:1750375002
Name:DEGRAW, MARCUS E (MD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:E
Last Name:DEGRAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22201 MOROSS RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2169
Mailing Address - Country:US
Mailing Address - Phone:313-343-3481
Mailing Address - Fax:313-343-7937
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:270
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-3481
Practice Address - Fax:313-343-7937
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074121208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4517317Medicaid
MI4517317Medicaid
H67991Medicare UPIN