Provider Demographics
NPI:1831552199
Name:DELUCA, MARIE ELIZABETH
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:DELUCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE
Mailing Address - Street 2:6G UHC
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-993-2529
Mailing Address - Fax:313-993-7703
Practice Address - Street 1:4201 ST. ANTOINE
Practice Address - Street 2:6G UHC
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-993-2529
Practice Address - Fax:313-993-7703
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298636207P00000X
MI4301510571207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine