Healthcare Provider Details

I. General information

NPI: 1477579878
Provider Name (Legal Business Name): MARC ADAM PLIZGA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 DIXIE HWY SUITE 104
CLARKSTON MI
48346-2087
US

IV. Provider business mailing address

6173 TYLER WOODS TRL
WHITE LAKE MI
48383-1972
US

V. Phone/Fax

Practice location:
  • Phone: 248-625-5998
  • Fax: 248-625-3975
Mailing address:
  • Phone: 248-625-5998
  • Fax: 248-625-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: