Provider Demographics
NPI:1043290232
Name:MARCHESE, ROBERT LEWIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:MARCHESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:25810 KELLY RD
Mailing Address - Street 2:SUIE 3
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4467
Mailing Address - Country:US
Mailing Address - Phone:586-777-9724
Mailing Address - Fax:586-777-9725
Practice Address - Street 1:25810 KELLY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4467
Practice Address - Country:US
Practice Address - Phone:586-777-9724
Practice Address - Fax:586-777-9725
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2020-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301055901207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4832040-10Medicaid