MEDICARE: DR. CARLOS MARCHENA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	CM040033	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	P41306	OTHER	MI	BLUE CARE NETWORK
3	0090010	OTHER	MI	BLUE CROSS BLUE SHIELD MI
4	XX27323	OTHER	MI	HEALTHPLUS OF MI

General Provider Information

NPI Number	:	1548374788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS MARCHENA M.D.

Provider Business Mailing Address
First Line	:	2464 WEXFORD DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48084-2712
Country	:	US
Telephone Number	:	248-703-0995
Fax Number	:

Provider Business Practice Location Address
First Line	:	3170 S PROFESSIONAL DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706
Country	:	US
Telephone Number	:	989-667-8872
Fax Number	:	989-686-8514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	07/08/2007

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