Healthcare Provider Details

I. General information

NPI: 1154038222
Provider Name (Legal Business Name): CARLO A MARCEAU PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42557 WOODWARD AVE STE 200
BLOOMFIELD HILLS MI
48304-5206
US

IV. Provider business mailing address

42557 WOODWARD AVE STE 200
BLOOMFIELD HILLS MI
48304-5206
US

V. Phone/Fax

Practice location:
  • Phone: 248-333-1170
  • Fax: 248-333-1175
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: