Healthcare Provider Details

I. General information

NPI: 1851850895
Provider Name (Legal Business Name): FRED MARO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FAREED SALLOOM-MAROW

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date: 05/20/2026
Reactivation Date: 07/14/2026

III. Provider practice location address

G3375 S SAGINAW ST
BURTON MI
48529-1277
US

IV. Provider business mailing address

225 E 5TH ST
FLINT MI
48502-1641
US

V. Phone/Fax

Practice location:
  • Phone: 810-406-4246
  • Fax:
Mailing address:
  • Phone: 810-406-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: